Family involvement on a dementia unit: the Resident Enrichment and Activity Program

Beyond the Dichotomy

Unit-level data describing dementia care attributes in 390 units in 123 Minnesota nursing facilities were used in a two-stage analytic procedure (1) to derive a typology of unit clusters and (2) to describe similarities and differences across unit clusters in terms of dementia care attributes and other unit characteristics not used to derive the typology. Nursing units were classified with combinations of environmental, programmatic, and staff attributes into six unit clusters. Most special care units (SCUs) were in a single unit cluster (dementia units) with the most dementia care attributes and serving mostly residents with dementia. Two unit clusters (small custodial units and rehabilitation units) were composed exclusively of non-SCUs, whereas remaining unit clusters (conventional units, large undifferentiated units, and heavy care units) consisted predominantly of non-SCUs with roughly equal proportions of residents with and without dementia. The typology offers a potentially useful way of classifying dementia care in nursing homes.

Stress, Social Engagement and Psychological Well-Being in Institutional Settings: Evidence Based on the Minimum Data Set 2.0

Alors qu'il existe une importante documentation sur la relation entre le stress, le soutien social et le bien-etrê chez les aîné(e)s vivant dans la communauté, peu d'études ont examiné la population des institutions. Cette étude a utilisé les données d'enquêtes pilotes du MDS 2.0 de trois hôpitaux ainsi que d'autres enquêtes reliées au bien-être psychologique. On a constaté que les patients les plus engagés socialement avaient tendance à afficher des niveaux plus élevés de bien-être et cette tendance était encore plus frappante chez ceux qui jouissaient d'un meilleur état de santé. La douleur était un prédicteur important de la réduction du bien-être. Étant donné que le MDS 2.0 fournit une approche complète à l'identification des problèmes sociaux, psychologiques et physiques et à leur réponse chez les aîné(e)s vivant en institution, il peut entraîner des effets importants sur le bien-être si on l'utilise à l'appui de la prise de décision et des interventions cliniques.

Balneotherapy, prevention of cognitive decline and care the Alzheimer patient and his family: outcome of a multidisciplinary workgroup

According to the latest forecasts of the INSEE - Institut National de la Statistique et des Etudes Economiques (National Statistics and Economic Studies Institute), ageing of the French population will increase between 2005 and 2050: whereas 20.8% of the population living in continental France reached the age of 60 years or more in 2005, this proportion would be of 30.6% in 2035 and 31.9% in 2050. In 2050, 22.3 million persons will have reached the age of 60 years or more compared to 12.6 million in 2005, increasing by 80% in a 45-year period. In line with the actual age pyramid, ageing is unavoidable, as those who will reach 60 years of age in 2050 are already born (in 1989 or before). This expansion will be most important between 2006 and 2035, when the numerous "baby-boom" generations born between 1946 and 1975, will reach these ages. In future years, lifespan improvement will only emphasize this increase. Even if life expectancy stabilizes at the 2005 level, the number of seniors reaching 60 years or more would still increase to 50% between 2005 and 2050. This issue is identical in all countries of the European Union. Ageing is a major risk factor for dementia that will considerably worsen in the next years, if no curative therapies are found. Today, 25 million persons in the world suffer from Alzheimer's disease (AD). In France, it is estimated that 860,000 persons are affected and that 225,000 news cases are annually diagnosed. After 75 years of age, more than 20% of women and 13% of men are concerned. Forecasts for the coming years are frightening. Considering ageing of the population, the number of Alzheimer's disease cases should raise to 1.3 million in 2020 (20 patients for 1000 inhabitants) ant 2.1 million in 2040 (30 patients for 1000 inhabitants).

Informal caregiver involvement and illness detection among cognitively impaired nursing home residents

BACKGROUND

The participation of informal caregivers in the care of nursing home (NH) residents has the potential to positively impact care, especially for cognitively impaired residents whose own ability to advocate for their care is often limited. This study examined relationships between the level of informal caregiver involvement (ICI) in the NH and the degree to which residents' common medical conditions were detected by facility staff.

METHODS

One hundred pairs of cognitively impaired residents and their primary informal caregivers were enrolled from three facilities in the Baltimore, Maryland area. Data collection involved interviews with informal caregivers and facility staff, as well as a medical evaluation and chart review of residents. A measure of illness detection was created by comparing a medical examination of the resident with chart review information. ICI was measured via staff rating and informal caregiver self-report.

RESULTS

Correlations between illness detection and ICI were significant, with r = -.46 (p <.001) and r = -.39 (p <.001), for staff rating and self-reports, respectively. In regression models taking into account resident characteristics (age, race, gender, comorbidities, payment status, duration of stay, and cognitive impairment) and facility differences, higher ICI and being female predicted higher rates of illness detection.

CONCLUSIONS

Though the cross-sectional nature of the study prevents the analysis of causal relationships, the involvement level of informal caregivers in the NH care of cognitively impaired residents was statistically related to higher rates of illness detection. Ramifications for the role of informal caregivers in long-term care are discussed.

Family involvement in residential long-term care: a synthesis and critical review

The objective of this review is to critically synthesize the existing literature on family involvement in residential long-term care. Studies that examined family involvement in various long-term care venues were identified through extensive searches of the literature. Future research and practice must consider the complexity of family structure, adopt longitudinal designs, provide direct empirical links between family involvement and resident outcomes, and offer rigorous evaluation of interventions in order to refine the literature.

Identifying Changeable Barriers to Family Involvement in the Nursing Home for Cognitively Impaired Residents

PURPOSE

Barriers to family involvement in the nursing home with the potential for change through intervention are examined, including transportation, caregiver health, relationships with staff, and resident characteristics.

DESIGN AND METHODS

Data were collected for 93 family caregiver-resident pairs by means of telephone interviews and chart review. Regression modeling was used to identify relationships between involvement (caregiver visit frequency) and the changeable barriers after the known variables of distance, kinship, payment source, length of stay, and cognitive function were taken into account.

RESULTS

Lower visit frequency was found for caregivers reporting problems with transportation, poor relationships with staff, and a smaller network of supportive family and friends. Higher caregiver anxiety was related to higher visit frequency.

IMPLICATIONS

Several barriers to family involvement are shown to be as or more influential than ones identified in previous research, thus providing empirical support for interventions currently used as well as suggesting new areas for intervention.

Family Caregiver Satisfaction With the Nursing Home After Placement of a Relative With Dementia

OBJECTIVE

This article examines family caregiver satisfaction after nursing home placement of a relative with Alzheimer disease or a related dementia. Determining what contributes to family caregiver satisfaction is a critical step toward implementing effective quality improvement strategies.

METHODS

A stress process model is used to study caregiver satisfaction among 285 family caregivers in relation to primary objective stressors (stage of dementia, length of stay, length of time in caregiving role, visitation frequency, involvement in nursing home, and involvement in hands-on care), subjective stressors (expectations for care), caregiver characteristics (education, marital status, familial relationship, workforce participation, distance from nursing home, and age), and organizational resources (rural/urban location, profit/nonprofit ownership, special care unit [SCU] designation, and custodial unit designation). SAS PROC MIXED is used in a multilevel analysis.

RESULTS

Higher satisfaction is associated with earlier stage of dementia, greater length of time involved in caregiving prior to institutionalization, higher visitation frequency, less involvement in hands-on care, greater expectations for care, and less workforce participation.

DISCUSSION

Multilevel analysis showed that primary stressors are the strongest predictors of satisfaction. Only one caregiver characteristic (work participation) and one organizational resource (rural/urban location) predict satisfaction. SCU designation was unrelated to satisfaction, perhaps because SCUs have less to offer residents in more advanced as opposed to earlier stages of Alzheimer disease. If family satisfaction is to be achieved, family presence in a nursing home needs to give caregivers a sense of positive involvement and influence over the care of their relative.

A cooperative communication intervention for nursing home staff and family members of residents

PURPOSE

This article reports on a randomized, controlled study of Partners in Caregiving, an intervention designed to increase cooperation and effective communication between family members and nursing home staff.

DESIGN AND METHODS

Participants included 932 relatives and 655 staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Parallel training sessions on communication and conflict resolution techniques were conducted with the family and staff in the treatment group, followed by a joint meeting with facility administrators.

RESULTS

Positive outcomes were found for both family and staff members in the treatment group. Both groups showed improved attitudes toward each other, families of residents with dementia reported less conflict with staff, and staff reported a lower likelihood of quitting.

IMPLICATIONS

Multiple studies report significant interpersonal stress between family members of nursing home residents and facility staff members. Partners in Caregiving appears to be an effective way to improve family-staff relationships in nursing homes.

Integrating theory, basic research, and intervention: two case studies from caregiving research

PURPOSE

The premise of this article is that interventions should be based explicitly on theory and basic research findings. Although there appears to be general agreement with that assertion, the connections among theory, research, and intervention in the field of gerontology are often tenuous or nonexistent. In this article, we argue for better integration of these three domains, providing two case studies from the Cornell Roybal Center that illustrate the positive role theory and research can play in intervention designs and broader applicability of findings.

DESIGN AND METHODS

Study 1 involved a social support intervention for persons making the transition to becoming a family caregiver. Study 2 was an organizational intervention designed to improve interpersonal relationships and increase mutual support between family caregivers and staff in nursing homes.

RESULTS

Several benefits emerged as a result of creating theoretically grounded and research-based interventions, including guidance for innovative intervention design and the production of findings that inform both basic research and intervention.

IMPLICATIONS

A much closer link between theory and basic research and intervention studies is indicated, suggesting that current federal support of translational research initiatives is justified and worthy of expansion.

Nurses' and family members'. Perceptions of nursing home residents' needs

The purpose of this study was to determine the degree of agreement between nursing home staff and families in assessing the needs of cognitively impaired nursing home residents. A convenience sample of 36 family members of nursing home residents with cognitive impairment and the nurses assigned to those patients was recruited from three nursing homes. The Nurse and Resident Perceptions Questionnaire, adapted from Lindgren and Linton (1991), was used to assess functioning in activities of daily living, physiologic, and psychosocial areas. Significant differences were found for eight items of physiologic and psychosocial functioning: difficulties with chewing, swelling of feet, orthopnea, weakness, easy bruising, recognition of people, lack of privacy, and boredom. Nurses rated all these areas less problematic than did the family members. Collaborative efforts of family members and nurses are needed to develop effective plans of care for these problems of nursing home residents with cognitive impairment.

Dimensions of care for dementia sufferers in long-term care institutions: are they related to outcomes?

OBJECTIVES

This study empirically examined whether dimensions of care cluster in special care units (SCUs) compared with non-SCUs. The relationship between SCU status plus separate measures of the dimensions of care and outcomes for dementia sufferers was then investigated.

METHODS

Data were drawn from the Intermediate Care Facility Project. The sample (N = 510) included residents with dementia, aged 65 and older, in intermediate care facilities throughout the province of British Columbia. Canada. Longitudinal data included 6 outcomes: cognitive function, behavioral problems of agitation and social skills, physical functioning, and quality of life measured through affect and expressive language skills. Separate multiple linear regression equations were estimated, relating each of these outcomes to 5 dimensions of care: preadmission and admission procedures. staff training and education, nonuse of physical and chemical restraints, flexible care routines and resident-relevant activities, and the environment.

RESULTS

The results showed there is virtually no clustering of dimensions along SCU/non-SCU lines. Neither SCU status nor the individual dimensions were highly predictive of outcomes. Residents' affect at t1 emerged as a characteristic that was significantly correlated with other outcomes.

DISCUSSION

This Canadian research can be added to the few but growing number of rigorous studies that suggest SCUs are not homogeneous and do not necessarily provide better care than non-SCUs. Moreover, it raises questions about the benefits of "best practice" dimensions of care, regardless of SCU status.

'It's not the same as him being at home': creating caring partnerships following nursing home placement

Admission to a nursing home is a major life event for both older people and family carers. Despite a policy of community care in both the UK and the US, entry to nursing homes will be an increasingly common event. Family carers are often the key decision makers but little is known about their experience of placement, especially adjustment after the event. Antagonistic relationships can often develop between staff and relatives, as the former seek to take over care and the latter to develop new roles. There is a need to create a partnership between staff and family so that the care of the older person is improved and the carers' need to remain involved is acknowledged.

Interventions for caregivers of patients with Alzheimer's disease: a review and analysis of content, process, and outcomes

Current reviews of the caregiver intervention literature have focused primarily on the outcomes of interventions for caregivers and general methodological limitations of individual studies (i.e., sampling and recruitment issues, adequacy of outcome measures, and generalization issues). Little attention has been paid to the specific factors affecting the therapeutic process, including the intensity and integrity of the interventions used. The purpose of this review is to examine closely the content and process of Alzheimer's disease (AD) caregiver interventions. We describe the types of interventions currently in use, factors affecting intervention outcomes, and we conclude with specific recommendations for the application of intervention technology and for the documentation of intervention research.

Satisfaction with nursing home care of a relative: does inviting greater input make a difference?

This study examined whether a formal invitation to have greater involvement in the nursing home care of their relatives resulted in increased satisfaction in former care-givers. The conceptual framework guiding the study was based on Roy's Adaptation model of Nursing (Roy 1984, 1989), since it was believed that the intervention might aid the adaptation of family members to the institutionalisation of a close friend or relative. Increased satisfaction with care was measured as evidence of adaptation. In the study, 31 former care-givers were randomly assigned to two groups, one of which was offered greater involvement in care. Of the participants in the experimental group, the four who accepted this opportunity all had relatives admitted in the past 6 months. After 6 weeks there was no significant difference between the groups. Trends suggest that similar programs may be most useful in the early months following admission, while care-givers are in the process of adapting to their new circumstances. It appears that nursing staff must be sensitive to the different needs for involvement in the care of relatives.

Institutionalization of an elderly family member: reactions of spouse and nonspouse caregivers

Although a prevalent clinical assumption is that the caregiver well-being improves following patient institutionalization, recent research challenges this assumption. In this article, the impact of patient institutionalization on the well-being of family caregivers is examined. Caregiver reaction, sense of general well-being and level of depression are compared pre- and postinstitutionalization and differences between spouse, adult child, and other caregivers are investigated.