To What Extent are Alberta Nursing Homes and Supportive Living Facilities Integrated with Their Community? A Sequential Quantitative-Qualitative Study

Background

Nursing homes and supportive living facilities (continuing care homes [CCH]) are often regarded as separate from their communities. Although occasional studies highlight volunteering or intergenerational activities, there is little systematic evaluation of the existence of activities in CCH that may promote community integration.

Methods

Study Design: The study utilized a sequential quantitative-qualitative approach: cross-sectional survey followed by semi-structured interviews. Setting: All registered long-term care (nursing home) and supportive living facilities (Levels 3, 4, and 4 Dementia) within Alberta. Subjects: The survey and interviews were conducted with directors of care. The survey was distributed to 334 facilities. Data saturation in the interviews was reached with seven participants.

Results

140 responses were received; 116 were analyzable (34.7% response rate). The range of activities varied widely. Prior to Covid-19, the most common were spiritual activities entering CCH (96.5%) and volunteers entering CCH (93.0%); CCH rarely had activities such as child daycare (5.2%). 12.9% of spiritual activities entering CCH had not been restarted following the pandemic, but homes were planning to restart this activity (16) or start it as a new activity (1). There was no statistically significant relationship between any activity and facility owner-operator model, size, type, or geography (urban/rural) at any survey time category. Four themes emerged from the interviews: resident quality of life and well-being, home's capacity and openness, sources of support, and planning and programming for implementation.

Conclusions

This study addresses a knowledge gap regarding community integration in CCH and provides insight on the types of community-integrated activities occurring in Alberta's CCH.

Relationship between staff and quality of care in care homes: StaRQ mixed methods study

Background

Quality of life and care varies between and within the care homes in which almost half a million older people live and over half a million direct care staff (registered nurses and care assistants) work. The reasons are complex, understudied and sometimes oversimplified, but staff and their work are a significant influence.

Objective(s)

To explore variations in the care home nursing and support workforce; how resident and relatives' needs in care homes are linked to care home staffing; how different staffing models impact on care quality, outcomes and costs; how workforce numbers, skill mix and stability meet residents' needs; the contributions of the care home workforce to enhancing quality of care; staff relationships as a platform for implementation by providers.

Design

Mixed-method (QUAL-QUANT) parallel design with five work packages. WP1 - two evidence syntheses (one realist); WP2 - cross-sectional survey of routine staffing and rated quality from care home regulator; WP3 - analysis of longitudinal data from a corporate provider of staffing characteristics and quality indicators, including safety; WP4 - secondary analysis of care home regulator reports; WP5 - social network analysis of networks likely to influence quality innovation. We expressed our synthesised findings as a logic model.

Setting

English care homes, with and without nursing, with various ownership structures, size and location, with varying quality ratings.

Participants

Managers, residents, families and care home staff.

Findings

Staffing's contribution to quality and personalised care requires: managerial and staff stability and consistency; sufficient staff to develop 'familial' relationships between staff and residents, and staff-staff reciprocity, 'knowing' residents, and skills and competence training beyond induction; supported, well-led staff seeing modelled behaviours from supervisors; autonomy to act. Outcome measures that capture the relationship between staffing and quality include: the extent to which resident needs and preferences are met and culturally appropriate; resident and family satisfaction; extent of residents living with purpose; safe care (including clinical outcomes); staff well-being and job satisfaction were important, but underacknowledged.

Limitations

Many of our findings stem from self-reported and routine data with known biases - such as under reporting of adverse incidents; our analysis may reflect these biases. COVID-19 required adapting our original protocol to make it feasible. Consequently, the effects of the pandemic are reflected in our research methods and findings. Our findings are based on data from a single care home operator and so may not be generalised to the wider population of care homes.

Conclusions

Innovative and multiple methods and theory can successfully highlight the nuanced relationship between staffing and quality in care homes. Modifiable characteristics such as visible philosophies of care and high-quality training, reinforced by behavioural and relational role modelling by leaders can make the difference when sufficient amounts of consistent staff are employed. Greater staffing capacity alone is unlikely to enhance quality in a cost-effective manner. Social network analysis can help identify the right people to aid adoption and spread of quality and innovation. Future research should focus on richer, iterative, evaluative testing and development of our logic model using theoretically and empirically defensible - rather than available - inputs and outcomes.

Study registration

This study is registered as PROSPERO CRD42021241066 and Research Registry registration: 1062.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/144/29) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.

Health effects of social connectedness in older adults living in congregate long-term care settings: A systematic review of quantitative and qualitative evidence

BACKGROUND

The overall impact of social connectedness on health outcomes in older adults living in nursing homes and assisted living settings is unknown. Given the unclear health impact of social connectedness for older adults in congregate long-term care settings worldwide, a comprehensive systematic review is required to evaluate the overall relationship between social connectedness and health outcomes for them.

OBJECTIVES

The purpose of this article was to synthesize the literature regarding the health impact of social connectedness among older adults living in nursing homes or assisted living settings.

METHODS

Using PRISMA guidelines, we identified eligible studies from Scopus, MEDLINE, PsycINFO, CINAHL and Cochrane databases (1990-2021). Bias and quality reporting assessment was performed using standardized criteria for cohort, cross sectional and qualitative studies. At each stage, ≥ 2 researchers conducted independent evaluations.

RESULTS

Of the 7350 articles identified, 25 cohort (follow-up range: 1 month-11 years; with two also contributing to cross sectional), 86 cross sectional, eight qualitative and two mixed methods were eligible. Despite different instruments used, many residents living in nursing homes and assisted living settings had reduced social engagement. Quantitative evidence supports a link between higher social engagement and health outcomes most studied (e.g. depression, quality of life). Few studies evaluated important health outcomes (e.g. cognitive and functional decline). Most cohort studies showed that lack of social connectedness accelerated time to death.

CONCLUSIONS

Social connectedness may be an important modifiable risk factor for adverse health outcomes for older adults living in nursing homes and assisted living facilities. Most studies were cross sectional and focused on quality of life and mental health outcomes. Longitudinal studies suggest that higher social engagement delays time to death. Evidence regarding other health outcomes important to older adults was scant and requires further longitudinal studies.

The association between material-psychological-behavioral framework of financial hardship and markers of inflammation: a cross-sectional study of the Midlife in the United States (MIDUS) Refresher cohort

BACKGROUND

Measures of financial hardship have been suggested to supplement traditional indicators of socioeconomic status (SES) to elucidate household economic well-being. This study formally tested the construct validity of financial hardship and examined its association with markers of inflammation.

METHODS

This study utilized data from the Midlife Development in the United States Refresher Study (MIDUS-R; Age = 23-76, 53.7% female, 71% white). Participants were divided into exploratory factor analysis (EFA; completed SAQs only; N = 2,243) and confirmatory factor analysis sample (CFA; completed SAQs and biomarker assessment; N = 863). Analysis was divided into three steps. First, exploratory factor analysis (EFA) is used to examine if the three-domain factor (material, psychological, and behavioral) is the best fitting model for financial hardship measures. Second, we conducted CFA to test the hypothesized three-factor measurement model of financial hardship. Third, we tested the association between domains and the general latent factor of financial hardship and inflammation (interleukin 6/IL6, c-reactive protein/CRP, and fibrinogen).

RESULTS

Results from EFA supported the three-domain model of financial hardship. The hypothesized three-domain measurement model fits well in a different sample within MIDUS-R. In the models adjusted for age and sex, higher material hardship was associated with elevated IL6, CRP, and fibrinogen, while higher behavioral hardship was associated with higher CRP. The association between the material domain and IL6 remained significant after adding body mass index, education, and race as additional covariates. The second-order financial hardship measurement model was associated with IL6, CRP, and fibrinogen, adjusted for age, sex, BMI, education, and race.

CONCLUSION

Explicating the socioeconomic environment to include indicators of financial hardship can help researchers better understand the pathway between SES and the inflammation process, which may help elucidate pathways between SES and age-related chronic diseases associated with inflammation.

Social Workers Critical to Honoring Commitments to Residents and Families in Long-Term Care

Social workers have been at the forefront of research and advocacy to improve nursing home care for several decades. However, United States (U.S.) regulations have not kept pace with professional standards, as nursing home social services workers are still not required to have a degree in social work and many are assigned caseloads that are untenable for providing quality psychosocial and behavioral health care. The National Academies of Sciences, Engineering, and Medicine (NASEM)'s recently published interdisciplinary consensus report, The National Imperative to Improve Nursing Home Quality: Honoring our Commitment to Residents, Families, and Staff (NASEM, 2022) makes recommendations for changing these regulations, reflecting years of social work scholarship and policy advocacy. In this commentary, we highlight the NASEM report recommendations for social work and chart a course for continuing scholarship and policy advocacy to improve resident outcomes.

Integrating social support into interventions among the elderly in nursing homes: a scoping review

OBJECTIVES

This study aimed to understand the evidence related to integration of social support into interventions, to identify literature gaps related to social support interventions, and to clarify dimensions of supportive functions, outcomes, and providers among the elderly in nursing homes.

DESIGN

This scoping review followed the approach by Arksey and O'Malley. The Mixed Methods Appraisal Tool V.2018 was used for quality assessment of the studies.

DATA SOURCES

Searches were conducted of the PubMed, ScienceDirect, Public Library of Science, SocioHub, Wiley Online Library and PsycINFO databases for publications from 2010 to 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We searched for primary studies and heterogeneous study designs published in English. Eligible studies took place in nursing and care homes and had study populations of elderly adults (older adults, geriatrics, ageing, seniors, older people and those aged 60 years and older).

DATA EXTRACTION AND SYNTHESIS

A data extraction form based on Joanna Briggs Institute's recommendations for scoping reviews was used. Two reviewers independently extracted data and performed quality assessment of the studies. Then, extracted data and quality assessment reports were discussed by all authors.

RESULTS

Thirty-one eligible studies were included in this review. 54.8% of the studies provided interventions for cognitively impaired residents. The top-three outcomes were neuropsychiatric symptoms, physical function and quality of life, respectively. The interventions were performed by nursing home staff (83.9%), other persons with specific qualifications (58.1%) and health volunteers (6.5%). Most studies (90.3%) depicted the integration of emotional and instrumental supportive functions into interventions.

CONCLUSION

The appropriate dimensions of supportive function, mainly emotional and instrumental support, are important to integrate into the social care of elderly people living in nursing homes.

Home- and community-level predictors of social connection in nursing home residents: A scoping review

Background and Aims

Social connection is associated with better physical and mental health and is an important aspect of the quality of care for nursing home residents. The primary objective of this scoping review was to answer the question: what nursing home and community characteristics have been tested as predictors of social connection in nursing home residents? The secondary objective was to describe the measures of social connection used in these studies.

Methods

We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), APA PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified associations between nursing home and/or community characteristics and resident social connection. Searches were limited to English-language articles published from database inception to search date (July 2019) and update (January 2021).

Results

We found 45 studies that examined small-scale home-like settings (17 studies), facility characteristics (14 studies), staffing characteristics (11 studies), care philosophy (nine studies), and community characteristics (five studies). Eight studies assessed multiple home or community-level exposures. The most frequent measures of social connection were study-specific assessments of social engagement (11 studies), the Index of Social Engagement (eight studies) and Qualidem social relations (six studies), and/or social isolation (five studies) subscales. Ten studies assessed multiple social connection outcomes.

Conclusion

Research has assessed small-scale home-like settings, facility characteristics, staffing characteristics, care philosophy, and community characteristics as predictors of social connection in nursing home residents. In these studies, there was no broad consensus on best approach(es) to the measurement of social connection. Further research is needed to build an evidence-base on how modifiable built environment, staffing and care philosophy characteristics-and the interactions between these factors-impact residents' social connection.

The influence of medical insurance and social security cards on the floating population's settlement intention

BACKGROUND

Medical insurance and social security cards are an important incentive for the floating population to live a stable life in their current residence, but there has been little studies on their effect on settlement intentions. Therefore, the purpose of this paper was to study the impact of basic medical insurance for urban employees and application for personal social security cards on the settlement intentions of the floating population. With the increase of the desire to settle, the health management and the development of public health will be improved.

METHODS

Based on the 2017 survey data from the dynamic monitoring of China's floating population, we explored the influence of basic medical insurance for urban employees and social security cards on the floating population's settlement intentions. Additionally, this study also examined the comprehensive causal relationship, with social integration as the mediator variable. We used SPSS 21.0 software. The input method was used to analyze the influence of the above variables by binary logistic regression. Then we used AMOS22.0 software to establish the structural equation model of the relationship between the above three independent variables. Finally, we used bootstrapping method to analyze the direct effect, indirect effect and total effect of independent variables on settlement intention.

RESULTS

The settlement intention of members of the floating population after participating in basic medical insurance for urban employees was 23.2% higher than that of those who did not participate. The decision as to whether to apply for a personal social security card is related to their settlement intention. The standardized regression coefficients among social insurance and security, social integration, and settlement intention were positive values, and the Z values of the overall effect, indirect effect, and direct effect were all greater than 1.96; the confidence interval of the indirect effect did not include 0. We found that this model is a partial intermediary model, with an intermediary ratio of 10.66%.

CONCLUSIONS

This article highlights the important impact of basic medical insurance for urban employees and individual social security cards on the floating population. The conclusions of this study provide suggestions for the government to use when designing policies to enhance the settlement intentions of the floating population and to improve the development of public health undertakings.

Care Transitions to the Community from Veterans Affairs Nursing Homes: Experiences of Social Connection and Disconnection

OBJECTIVE

This study aimed to further knowledge of older Veterans' experiences with transitioning to the community from Veterans Affairs nursing homes (Community Living Centers or CLCs) with emphasis on social functioning.

DESIGN

A qualitative study design was used in addition to administration of standardized depression and mental status screens.

SETTING AND PARTICIPANTS

Veterans (n = 18) and caregivers (n = 14) were purposively sampled and recruited from 2 rural CLCs in Upstate New York.

METHODS

Semistructured interviews were completed with Veterans in the CLC prior to discharge (to explore experiences during the CLC stay and expectations regarding discharge and returning home) and in the home 2-4 weeks postdischarge (to explore daily routines and perceptions of overall health, mental health, and social functioning). Caregivers participated in 1 interview, completed postdischarge. The 9-item Patient Health Questionnaire and the Brief Interview for Mental Status were administered postdischarge.

RESULTS

Thematic analysis of verbatim transcriptions revealed 3 inter-related themes: (1) Veterans may experience improved social connectedness in CLCs by nature of the unique care environment (predominantly male, shared military experience); (2) Experiences of social engagement and connectedness varied after discharge and could be discordant with Veterans' expectations for recovery prior to discharge; and (3) Veterans may or may not describe themselves as "lonely" after discharge, when physically isolated. Veterans lacked moderate to severe cognitive impairment (Brief Interview for Mental Status: range = 14-15); however, they reported a wide range in depressive symptom severity postdischarge (9-item Patient Health Questionnaire: mean = 4.9, SD = 6.1, median/mode = 3, range = 0-23).

CONCLUSIONS AND IMPLICATIONS

This study identified a potential for increased social isolation and disengagement after discharge from Veterans Affairs nursing homes. Nursing homes should integrate social functioning assessment for their residents, while extending care planning and transitional care to address patient-centered social functioning goals.

Understanding the staff behaviours that promote quality for older people living in long term care facilities: A realist review

BACKGROUND

Little is known about how the workforce influences quality in long term care facilities for older people. Staff numbers are important but do not fully explain this relationship.

OBJECTIVES

To develop theoretical explanations for the relationship between long-term care facility staffing and quality of care as experienced by residents.

DESIGN

A realist evidence synthesis to understand staff behaviours that promote quality of care for older people living in long-term care facilities.

SETTING

Long-term residential care facilities PARTICIPANTS: Long-term care facility staff, residents, and relatives METHODS: The realist review, (i) was co-developed with stakeholders to determine initial programme theories, (ii) systematically searched the evidence to test and develop theoretical propositions, and (iii) validated and refined emergent theory with stakeholder groups.

RESULTS

66 research papers were included in the review. Three key findings explain the relationship between staffing and quality: (i) quality is influenced by staff behaviours; (ii) behaviours are contingent on relationships nurtured by long-term care facility environment and culture; and (iii) leadership has an important influence on how organisational resources (sufficient staff effectively deployed, with the knowledge, expertise and skills required to meet residents' needs) are used to generate and sustain quality-promoting relationships. Six theoretical propositions explain these findings.

CONCLUSION

Leaders (at all levels) through their role-modelling behaviours can use organisational resources to endorse and encourage relationships (at all levels) between staff, residents, co-workers and family (relationship centred care) that constitute learning opportunities for staff, and encourage quality as experienced by residents and families.

Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19

OBJECTIVES

Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19.

DESIGN

Scoping review.

SETTINGS AND PARTICIPANTS

Residents of LTC homes, care homes, and nursing homes.

METHODS

We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; we limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, we included studies that reported (1) the association between social connection and a mental health outcome, (2) the association between a modifiable risk factor and social connection, or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), we identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the articles that informed these strategies.

RESULTS

We included 133 studies in our review. We found 61 studies that tested the association between social connection and a mental health outcome. We highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families, and staff build and maintain social connection for LTC residents.

CONCLUSIONS AND IMPLICATIONS

Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.

Social networks and health in later life: a state of the literature

Late life is a period frequently marked by decline in personal health and heightened need for social support. Consequently, the social networks in which individuals are embedded assume an increasingly central role in the health and wellbeing of older adults. In the present article, I review the state of the literature on social networks and health in later life. By drawing on insights from the sociology of ageing and the life course, I address new developments and current challenges within the field. Chief among these developments and challenges is the recognition that the ageing process does not occur in a vacuum. Rather, individuals are consistently exposed to numerous changes to their social lives which have strong implications for current and future health outcomes. Upon highlighting the latest innovations within the field of networks and health, I conclude with useful directions for future research.

Substitute decision makers' experiences of making decisions at end of life for older persons with dementia: A systematic review and qualitative meta-synthesis

BACKGROUND

Substitute decision makers are important for people with advanced dementia, particularly at the end of life. Substitute decision makers report issues in providing support, and physical and psychological consequences from the role. However, there is no synthesised evidence about how substitute decision makers are affected by and experience making decisions for older persons diagnosed with dementia at end of life. Methodology: A protocol for a qualitative systematic review was developed. Seven articles met both inclusion and research quality criteria following a comprehensive search for published and unpublished studies (January 2007-2017, English language). Meta-synthesis was achieved through meta-aggregation of the results from included studies.

RESULTS

Meta-aggregation of 20 themes into eight categories resulted in five synthesised findings. The findings were: 'trust'; 'guilt, mistrust and confusion'; 'translating quality of life'; 'negotiating families'; and 'uncertainty and reactivity'. Trust in healthcare personnel positively affected substitute decision makers and supported their adaptability. Substitute decision makers experienced guilt, mistrust, and confusion as they encountered increased complexity in care and health interventions as social needs changed. Substitute decision makers experienced complexities and struggles as they interpreted quality of life and negotiated end of life treatment decisions. Substitute decision makers experienced practical needs to negotiate family as they fulfilled their support roles. Ambiguity in advance care plans, limited knowledge of dementia, end of life uncertainties, and communication issues reduced substitute decision makers' proactivity. Implications: Being a substitute decision maker for people with advanced dementia at end of life is stressful. Health professionals need to be cognizant of substitute decision makers experiences and needs, and identify mechanisms to achieve support and education. The findings generate need for further investigation of interventions to meet the needs of substitute decision makers.

Assessment of health inequality between urban-to-urban and rural-to-urban migrant older adults in China: a cross-sectional study

BACKGROUND

Many studies focused on health inequality between migrant older adults and local older adults, while few study concerned the health inequalities between urban-to-urban and rural-to-urban migrant older adults. This study aimed to compare physical health and mental health between these two groups in Hangzhou, Zhejiang Province, China, and to explore the relationship between cognitive social capital, social integration and health among migrant older adults.

METHODS

A two-stage stratified sampling method was employed to recruit participants from May to August 2013 in Hangzhou. Measurement data were compared with student's t-tests and multivariate analysis of variance (MANOVA). Multiple linear regression was adopted in this study.

RESULTS

A total of 1000 of participants who met the inclusion criteria were analyzed, consisting of 527 (52.7%) urban-to-urban and 473 (47.3%) rural-to-urban migrant older adults. There were no statistically significant difference in physical health and mental health between urban-to-urban and rural-to-urban groups on the whole. However, urban-to-urban migrant older adults had a higher reciprocity and social integration than did in rural-to-urban group (13.36 vs. 12.50, p < 0.01; 40.07 vs. 38.50, p < 0.01). And both of cognitive social capital and social integration were positively related to physical health (social reciprocity: t = 6.69, p < 0.01; social trust: t = 3.27, p < 0.01; social integration: t = 5.66, p < 0.01) and mental health (social reciprocity: t = 4.49, p < 0.01; social trust: t = 5.15, p < 0.01; social integration: t = 10.02, p < 0.01). Overall, the female, widowed, and the oldest among migrant older adults had a worse health.

CONCLUSIONS

Social capital and social integration were played important roles in health of migrant older adults. The female rural-to-urban migrant older adults, those aged over 70 years, and older adults who were not in marriage should be especially concerned in health policy making.

Social integration and loneliness among long-term care home residents: protocol for a scoping review

INTRODUCTION

Social well-being is associated with better physical and mental health. It is also important for quality of life, including from the perspectives of those living in long-term care (LTC) homes. However, given the characteristics of the LTC home environment and the people who live there, the nature and influence of social integration and loneliness, and strategies to address them, may differ in this population compared with those living in the community. The objective of this scoping review is to provide an overview of the nature and extent of research on social integration and loneliness among LTC home residents, including a summary of how these concepts have been operationalised and any evidence from specific groups.

METHODS AND ANALYSIS

This study protocol describes the methods of a scoping review of peer-reviewed literature related to social integration and loneliness among LTC home residents. A literature search was developed by an Information Specialist and will be conducted in MEDLINE(R) ALL (in Ovid, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily) and then translated into CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (Proquest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid) and AgeLine (EBSCO). Two reviewers will independently screen titles and abstracts of articles identified in the search. Two reviewers will then independently review full text articles for inclusion. Data extraction will also be carried out in duplicate. We will engage LTC home community members, including residents, family and staff, to refine the review questions, assist in interpreting the results and participate in knowledge translation.

ETHICS AND DISSEMINATION

Ethics approval is not required. We will present findings at conferences and publish in a peer-reviewed journal. Ultimately, we hope to inform future observational and interventional research aimed at improving the health and quality of life of LTC home residents.

Life Course Socioeconomic Status, Daily Stressors, and Daily Well-Being: Examining Chain of Risk Models

Objectives

This article models the chain of risk that links life course socioeconomic status (SES), daily stressor exposure and severity, and daily well-being.

Method

Data from the main survey and the daily diary project of the Midlife in the United States (MIDUS) Refresher study were combined, resulting in 782 participants (55.6% female; age 25-74, Mage = 47.9) who reported on 5,849 days of information on daily stressors and daily well-being. Data were measured at both person and day levels. Between-person predictor variables include childhood SES, education, and adult SES. Within-person daily variables assessed exposure to daily stressors, severity of daily stressors, positive affect, negative affect, and daily physical symptoms. We contrasted hypothesized models, the chain of risk trigger effect model versus the additive model within a multilevel structural equation modeling framework.

Results

The influences of life course SES and daily stressor exposure and severity on daily well-being were better described by the chain of risk additive model than the chain of risk trigger effect model. Childhood SES was directly and indirectly (through education, adult SES, and daily stressor exposure and severity) associated with daily well-being (in between-person level), especially daily physical symptoms and daily negative affect.

Discussion

Childhood may be a sensitive period that has salient implications for day-to-day well-being later in life.

The planning and reporting of mixed methods studies on the built environment and health

Researchers examining the influence of the built environment on health are increasingly using mixed methods approaches. The use of more than one type of methodology to address a single research question is compelling in this field because researchers investigating the impact of the built environment on health have been faced with proposing solutions to a complex societal problem involving interacting systems and social uncertainties. Mixed methods studies can help researchers to gain a better understanding of the relationships that exist between humans and their environment by drawing on qualitative and quantitative methods. Mixed methods studies could also be instrumental for providing effective policy solutions. This is because they allow researchers to identify built environment determinants of health in a population of interest and to understand the social and cultural factors that might influence the uptake of an intervention by this population. The objective of this paper is to assist those conducting research on the built environment and health who may have little background in mixed methods. We provide an overview of mixed methods research designs and provide concrete techniques for the integration of diverse methods. We also discuss the recommendations for mixed methods research in the field of built environment - health research, drawing on specific examples from published studies. Reporting a research design and an integration strategy in mixed methods studies could help to strengthen our ability to gain new insights into the multidimensional nature of the relationship between the built environment and health.

Social and leisure activity profiles and well-being among the older adults: a longitudinal study

OBJECTIVES

Studies highlight the beneficial effects of social and leisure activities on the well-being of aging people. Our aims were: to investigate activity profiles among older adults living in their own homes, to highlight potential changes in profiles over a period of five years and to examine effects of differences between these profiles on well-being variables.

METHODS

Three waves were considered in this longitudinal study, with 550, 410 and 374 people (76, 79, 82 years on average), respectively. We used cluster analysis to obtain activity profiles of social and leisure activities, ANOVAs with age and external variables (satisfaction with life, time occupation satisfaction, self-esteem and depression) to explore differences between cluster groups, and chi-square tests of association to explore whether the same individual belonged to the same activity profile over time.

RESULTS

The number of clusters decreased strongly from the first wave to the other two waves (n = 7 to n = 2 and 3). Two main types of activity differentiated the profiles: social activities (voluntary work and associations) and recreational activities outside the home/at home. The activities showed no systematic or strong effects on external variables, nevertheless for the oldest subjects when comparing the less active to the more active (recreational profile and social profile) the latter expressed a greater satisfaction of time occupation and self-esteem, and lower scores of depressive symptoms.

CONCLUSIONS

Such activities could be an indicator of a certain independence (physical and mental availability) which plays a strong role in the well-being of older adults.

Goals of Care or Goals of Trust? How Family Members Perceive Goals for Dying Nursing Home Residents

PURPOSE OF STUDY

Dementia affects more than 5 million Americans, and is a leading cause of death. Family members of nursing home (NH) residents with advanced dementia report difficulty making decisions about care toward the end of life. As part of a randomized trial testing an intervention to improve decision making, this qualitative study aimed to understand how family decision makers experienced goal-based decision making in advance of the death of their relative.

DESIGN AND METHODS

This qualitative study was conducted as part of the goals of care clinical trial. Study participants (n = 16) were family decision makers in North Carolina whose relative with advanced dementia died after participating in the goals of care intervention. Semi-structured interviews were analyzed using a qualitative description approach.

RESULTS

Family members' experience of decision making and death differed based on the presence or absence of trusting relationships with NH staff. Family members who reported trust described a positive end-of-life experience and less need for prescribed goals of care discussions. In the absence of trust, family members reported that goals of care discussions were ignored by staff or created confusion.

IMPLICATIONS

Among family members of persons who recently died from dementia in NHs, expressions of trust in staff were strongly related to perceptions of decision making about goals of care. Although goals of care discussions may potentially promote communication to earn trust, the presence of pre-existing trust ultimately influenced the decision making and end-of-life experiences of residents and families.

Can Caring Create Prejudice? An Investigation of Positive and Negative Intergenerational Contact in Care Settings and the Generalisation of Blatant and Subtle Age Prejudice to Other Older People

Caring is a positive social act, but can it result in negative attitudes towards those cared for, and towards others from their wider social group? Based on intergroup contact theory, we tested whether care workers' (CWs) positive and negative contact with old‐age care home residents (CHRs) predicts prejudiced attitudes towards that group, and whether this generalises to other older people. Fifty‐six CWs were surveyed about their positive and negative contact with CHRs and their blatant and subtle attitudes (humanness attributions) towards CHRs and older adults. We tested indirect paths from contact with CHRs to attitudes towards older adults via attitudes towards CHRs. Results showed that neither positive nor negative contact generalised blatant ageism. However, the effect of negative, but not positive, contact on the denial of humanness to CHRs generalised to subtle ageism towards older adults. This evidence has practical implications for management of CWs' work experiences and theoretical implications, suggesting that negative contact with a subgroup generalises the attribution of humanness to superordinate groups. Because it is difficult to identify and challenge subtle prejudices such as dehumanisation, it may be especially important to reduce negative contact. © 2016 The Authors. Journal of Community & Applied Social Psychology Published by John Wiley & Sons Ltd.

Residents Perceptions of Friendship and Positive Social Networks Within a Nursing Home

PURPOSE OF THE STUDY

(i) To describe nursing home residents' perceptions of their friendship networks using social network analysis (SNA) and (ii) to contribute to theory regarding resident friendship schema, network structure, and connections between network ties and social support.

DESIGN AND METHODS

Cross-sectional interviews, standardized assessments, and observational data were collected in three care units, including a Dementia Specific Unit (DSU), of a 94-bed Sydney nursing home. Full participation consent was obtained for 36 residents aged 63-94 years. Able residents answered open-ended questions about friendship, identified friendship ties, and completed measures of nonfamily social support.

RESULTS

Residents retained clear concepts of friendship and reported small, sparse networks. Nonparametric pairwise comparisons indicated that DSU residents reported less perceived social support (median = 7) than residents from the other units (median = 17; U = 10.0, p = .034, r = -.51), (median = 14; U = 0.0, p = .003, r = -.82). Greater perceived social support was moderately associated with higher number of reciprocated ties [ρ(25) = .49, p = .013].

IMPLICATIONS

Though some residents had friendships, many reported that nursing home social opportunities did not align with their expectations of friendship. Relationships with coresidents were associated with perceptions of social support. SNA's relational perspective elucidated network size, tie direction, and density, advancing understanding of the structure of residents' networks and flow of subjective social support through that structure. Understanding resident expectations and perceptions of their social networks is important for care providers wishing to improve quality of life in nursing homes.