1
|
van de Beek SH, Erdal A, Husebø BS, Vislapuu M, Achterberg WP, Caljouw MAA. Impact of Pain and Neuropsychiatric Symptoms on Activities in Nursing Home Residents (COSMOS Trial). J Am Med Dir Assoc 2024; 25:847-852.e3. [PMID: 38403273 DOI: 10.1016/j.jamda.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE This study aims to identify whether pain and dementia-related behavior are associated with different types of activities in nursing home residents, controlled for dementia severity. DESIGN Cross-sectional baseline data from the multicomponent cluster randomized controlled COSMOS trial (acronym for Communication, Systematic pain treatment, Medication review, Organization of activities, and Safety). SETTING AND PARTICIPANTS A total of 723 patients from 33 Norwegian nursing homes with 67 units (clusters). Participants aged ≥65 years, with a life expectancy of >6 months, and with valid data on activity were eligible for inclusion. METHODS Activity was operationalized in time (hours per week) and type (cognitive, social, physical, and no activity). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), pain with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and behavior with the Neuropsychiatric Inventory Nursing Home version (NPI-NH). Analyses were performed using linear and logistic regression. Sensitivity analyses for dementia severity were performed to account for effect modification. RESULTS A total of 289 participants were included (mean age 86.2 [SD 7.6]; 74% female). A higher pain score was associated with less time spent on activity in participants with severe dementia (estimate 0.897, P = .043). A higher score for the NPI-NH mood cluster (depression and anxiety) was associated with a higher likelihood of participation in cognitive activities (odds ratio [OR], 1.073; P = .039). Apathy (OR, 0.884; P = .041) and lack of inhibition (OR, 0.904; P = .042) were associated with a lower likelihood of participation in social activities as well as no engagement in activities (apathy OR, 0.880; P = .042; lack of inhibition OR, 0.894; P = .034). CONCLUSION AND IMPLICATIONS Pain and dementia-related behavior may influence the participation in activities in the nursing home. There is an urgent need to investigate what type of activity stimulates people in different stages of dementia.
Collapse
Affiliation(s)
- Sifra H van de Beek
- Department of Internal Medicine, Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands; Department of Ethics and Law, Leiden University Medical Center, Leiden, the Netherlands; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Ane Erdal
- Department of Global Public Health and Primary Care, Center for Elderly and Nursing Home Medicine (SEFAS), Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Bettina S Husebø
- Department of Global Public Health and Primary Care, Center for Elderly and Nursing Home Medicine (SEFAS), Faculty of Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Maarja Vislapuu
- Department of Global Public Health and Primary Care, Center for Elderly and Nursing Home Medicine (SEFAS), Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
2
|
Möhler R, Calo S, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care. Cochrane Database Syst Rev 2023; 3:CD009812. [PMID: 36930048 PMCID: PMC10010156 DOI: 10.1002/14651858.cd009812.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND People with dementia who are being cared for in long-term care settings are often not engaged in meaningful activities. We wanted to know whether offering them activities which are tailored to their individual interests and preferences could improve their quality of life and reduce agitation. This review updates our earlier review published in 2018. OBJECTIVES ∙ To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in long-term care facilities. ∙ To describe the components of the interventions. ∙ To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, on 15 June 2022. We also performed additional searches in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and the World Health Organization (WHO) ICTRP, to ensure that the search for the review was as up-to-date and as comprehensive as possible. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials offering personally tailored activities. All interventions included an assessment of the participants' present or past preferences for, or interest in, particular activities as a basis for an individual activity plan. Control groups received either usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two authors independently selected studies for inclusion, extracted data and assessed the risk of bias of included studies. Our primary efficacy outcomes were agitation and participant quality of life. Where possible, we pooled data across studies using a random effects model. MAIN RESULTS We identified three new studies, and therefore included 11 studies with 1071 participants in this review update. The mean age of participants was 78 to 88 years and most had moderate or severe dementia. Ten studies were RCTs (three studies randomised clusters to the study groups, six studies randomised individual participants, and one study randomised matched pairs of participants) and one study was a non-randomised clinical trial. Five studies included a control group receiving usual care, five studies an active control group (activities which were not personally tailored) and one study included both types of control group. The duration of follow-up ranged from 10 days to nine months. In nine studies personally tailored activities were delivered directly to the participants. In one study nursing staff, and in another study family members, were trained to deliver the activities. The selection of activities was based on different theoretical models, but the activities delivered did not vary substantially. We judged the risk of selection bias to be high in five studies, the risk of performance bias to be high in five studies and the risk of detection bias to be high in four studies. We found low-certainty evidence that personally tailored activities may slightly reduce agitation (standardised mean difference -0.26, 95% CI -0.53 to 0.01; I² = 50%; 7 studies, 485 participants). We also found low-certainty evidence from one study that was not included in the meta-analysis, indicating that personally tailored activities may make little or no difference to general restlessness, aggression, uncooperative behaviour, very negative and negative verbal behaviour (180 participants). Two studies investigated quality of life by proxy-rating. We found low-certainty evidence that personally tailored activities may result in little to no difference in quality of life in comparison with usual care or an active control group (MD -0.83, 95% CI -3.97 to 2.30; I² = 51%; 2 studies, 177 participants). Self-rated quality of life was only available for a small number of participants from one study, and there was little or no difference between personally tailored activities and usual care on this outcome (MD 0.26, 95% CI -3.04 to 3.56; 42 participants; low-certainty evidence). Two studies assessed adverse effects, but no adverse effects were observed. We are very uncertain about the effects of personally tailored activities on mood and positive affect. For negative affect we found moderate-certainty evidence that there is probably little to no effect of personally tailored activities compared to usual care or activities which are not personalised (standardised mean difference -0.02, 95% CI -0.19 to 0.14; 6 studies, 632 participants). We were not able to undertake meta-analyses for engagement and sleep-related outcomes, and we are very uncertain whether personally tailored activities have any effect on these outcomes. Two studies that investigated the duration of the effects of personally tailored activities indicated that the intervention effects they found persisted only during the period of delivery of the activities. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia in long-term care may slightly reduce agitation. Personally tailored activities may result in little to no difference in quality of life rated by proxies, but we acknowledge concerns about the validity of proxy ratings of quality of life in severe dementia. Personally tailored activities probably have little or no effect on negative affect, and we are uncertain whether they have any effect on positive affect or mood. There was no evidence that interventions were more likely to be effective if based on one theoretical model rather than another. We included three new studies in this updated review, but two studies were pilot trials and included only a small number of participants. Certainty of evidence was predominately very low or low due to several methodological limitations of and inconsistencies between the included studies. Evidence is still limited, and we remain unable to describe optimal activity programmes. Further research should focus on methods for selecting appropriate and meaningful activities for people in different stages of dementia.
Collapse
Affiliation(s)
- Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Stella Calo
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Renom
- Department of Geriatrics, Parc de Salut Mar, Barcelona, Spain
| | - Helena Renom
- Physical Medicine and Rehabilitation (MFRHB), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
3
|
Plys E, Qualls SH. Programmed Activity Attendance in Assisted Living: An Application of the Theory of Planned Behavior with Additional Health Factors. Clin Gerontol 2022; 45:1214-1225. [PMID: 31354090 PMCID: PMC6987002 DOI: 10.1080/07317115.2019.1645781] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Programmed activities contribute to the quality of life of assisted living (AL) residents, but attendance rates are often quite low. Using the theory of planned behavior (TPB), this study explores relationships among social cognitive variables, multidimensional health factors, and programmed activity attendance in AL.Methods: In a cross-sectional survey, 185 AL residents (Mage = 83.64, SD = 9.64) self-reported physical and mental health; TPB constructs (i.e., attitudes, subjective norms, behavioral control, and behavioral intention); and the percentage of programmed activities attended in the previous week.Results: Structural modeling showed that TPB was a good fit for the data (χ2/DF = 1.67; CFI = .97; TLI = .96; RMSEA = .06), explaining 82% of variance in behavioral intention and 44% of variance in activity attendance. After adding health factors to the model, only mental health yielded a significant indirect effect on activity attendance.Conclusion: Results provide preliminary support for the viability of TPB as a framework to explain resident activity attendance in AL. Thus, the decision to attend programmed activities in AL may represent a social cognitive process, influenced by mental health.Clinical Implications: Interventions may consider targeting TPB constructs and mental health to increase activity behaviors amongst AL residents.
Collapse
Affiliation(s)
- Evan Plys
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
- General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sara H. Qualls
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
- Gerontology Center, University of Colorado, Colorado Springs, CO, USA
| |
Collapse
|
4
|
Hayward JK, Gould C, Palluotto E, Kitson E, Fisher ER, Spector A. Interventions promoting family involvement with care homes following placement of a relative with dementia: A systematic review. DEMENTIA 2021; 21:618-647. [PMID: 34894796 PMCID: PMC8811321 DOI: 10.1177/14713012211046595] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a wealth of literature investigating the role of family involvement within care homes following placement of a relative with dementia. This review summarises how family involvement is measured and aims to address two questions: (1) which interventions concerning family involvement have been evaluated? And (2) does family involvement within care homes have a positive effect on a resident’s quality of life and behavioural and psychological symptoms of dementia? After searching and screening on the three major databases PsycINFO, MEDLINE and CINAHL Plus for papers published between January 2005 and May 2021, 22 papers were included for synthesis and appraisal due to their relevance to family involvement interventions and or family involvement with resident outcomes. Results show that in 11 interventions designed to enhance at least one type of family involvement, most found positive changes in communication and family–staff relationships. Improvement in resident behavioural and psychological symptoms of dementia was reported in two randomised controlled trials promoting partnership. Visit frequency was associated with a reduction of behavioural and psychological symptoms of dementia for residents with moderate dementia. Family involvement was related to positive quality of life benefits for residents. Contrasting results and methodological weaknesses in some studies made definitive conclusions difficult. Few interventions to specifically promote family involvement within care homes following placement of a relative with dementia have been evaluated. Many proposals for further research made over a decade ago by Gaugler (2005) have yet to be extensively pursued. Uncertainty remains about how best to facilitate an optimum level and type of family involvement to ensure significant quality of life and behavioural and psychological symptoms of dementia benefits for residents with dementia.
Collapse
Affiliation(s)
- Janine K Hayward
- Research Department of Clinical, Educational and Health Psychology, 4919University College London, London, UK
| | - Charlotte Gould
- Department of Psychology, 3162Royal Holloway, University of London, Egham, UK
| | - Emma Palluotto
- Department of Clinical Psychology, 4917University of East London, London, UK
| | - Emily Kitson
- Department of People and Organisations, 411270Surrey Business School, University of Surrey, Guildford, UK
| | - Emily R Fisher
- Research Department of Clinical, Educational and Health Psychology, 4919University College London, London, UK
| | - Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, 4919University College London, London, UK
| |
Collapse
|
5
|
Liu W, Kim S. Dyadic interactions and physical and social environment in dementia mealtime care: a systematic review of instruments. Ann N Y Acad Sci 2021; 1505:23-39. [PMID: 34310706 PMCID: PMC8688242 DOI: 10.1111/nyas.14667] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/16/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
Using valid instruments to measure dyadic interactions and physical and social environment during mealtime care of persons with dementia is critical to evaluate the process, fidelity, and impact of mealtime interventions. However, the characteristics and quality of existing instruments remain unexplored. This systematic review described the characteristics and synthesized the psychometric quality of instruments originally developed or later modified to measure mealtime dyadic interactions and physical and/or social dining environment for people with dementia, on the basis of published reports between January 1, 1980 and December 31, 2020. We identified 26 instruments: 17 assessed dyadic interactions, one assessed physical environment, and eight assessed physical and social environment. All instruments were used in research and none in clinical practice. All instruments were observational tools and scored as having low psychometric quality, except for the refined Cue Utilization and Engagement in Dementia (CUED) mealtime video-coding scheme rated as having moderate quality. Reasons for low quality are the use of small samples compared with the number of items, limited psychometric testing, and inadequate estimates. All existing tools warrant further testing in larger diverse samples in varied settings and validation for use in clinical practice. The refined CUED is a potential tool for use and requires testing in direct on-site observations.
Collapse
Affiliation(s)
- Wen Liu
- The University of Iowa, College of Nursing, Iowa City, IA, USA
| | - Sohyun Kim
- The University of Iowa, College of Nursing, Iowa City, IA, USA
| |
Collapse
|
6
|
Who Visits Relatives in Nursing Homes? Predictors of at Least Weekly Visiting. J Am Med Dir Assoc 2021; 23:1153-1158.e1. [PMID: 34634232 DOI: 10.1016/j.jamda.2021.09.011] [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] [Received: 07/08/2021] [Accepted: 09/12/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Within the context of a single study, assess the relative importance of the 6 factors identified in a 2019 systematic review as associated with the likelihood that family members will visit nursing home residents. DESIGN Retrospective statistical analysis of an existing survey data set. SETTINGS AND PARTICIPANTS A national survey conducted with 4350 relatives of long-term nursing home residents. METHODS Probit models of the probability of visiting a family member at least once weekly, stratified by age of the visitor, were estimated. To account for possible endogeneity of respondent involvement in the choice of nursing home and visit rate, visit rates were estimated using 2-stage residual inclusion in which the first stage explained involvement in nursing home choice. RESULTS Involvement in nursing home choice has a substantively and statistically significant positive effect on visit probability for all age groups of respondents. Travel time has a substantively and statistically significant negative association on visit probability for all age groups. Younger women are more likely to visit than younger men. For all but the oldest respondents, higher income and full-time employment contribute to involvement in nursing home choice as does being Black or Hispanic. CONCLUSIONS AND IMPLICATIONS As in previous research, travel time is an important determinant of visit rates. The strong association of involvement in nursing home choice with visit probability suggests a strong psychological motivation for visiting. To improve visiting, future research should focus on better understanding of the psychological factors that are associated with it and rely on better data and improved statistical methods. Our findings also suggest that nursing home administrators should consider adopting initiatives to facilitate and empower family members' involvement in nursing home choice, which in turn may lead to increased visitations.
Collapse
|
7
|
Family involvement with care homes following placement of a relative living with dementia: a review. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
This review updated a previous review [Gaugler JE (2005) Family involvement in residential long-term care: a synthesis and critical review. Aging and Mental Health9, 105–118] and focused on dementia. Fourteen years of development in family involvement with care homes following placement of a relative was explored. The review aimed to investigate two questions: (1) What types of involvement do families have with care homes following placement of people living with dementia? (2) Which factors influence family involvement with care homes? PsycINFO, MEDLINE and CINAHL Plus were searched for publications between January 2005 and December 2018. Thirty-three papers representing 30 studies were included. Papers were appraised using a quality rating tool designed for use with mixed study designs. Studies were of a reasonable quality though some weaknesses included single-site samples, high attrition rates and poor reporting. Twenty-eight papers highlighted types of involvement including collaboration, family–staff relationship development, decision making and visiting. Twenty-five papers pertained to factors influencing involvement, which included outcome of care quality evaluation, wish for recognition and sense of integration into the care team. Type of family involvement has changed over time with increased emphasis on families’ desire for partnership, to be active rather than passive advocates, and to focus on care monitoring and evaluation. Seven themes of family involvement activities are featured and a non-linear process is proposed. When compared to patient and family-centred care principles, an analysis of family involvement types found good fit overall and potential for framework improvements. Over 30 diverse factors influence inter-family variation in the level and nature of family involvement. Consideration of these factors and resolution of the gaps in evidence, including intergenerational and cultural concerns, can improve care home facilitation of family participation. This dementia-specific review is a comprehensive timely complement to Gaugler's seminal work about older adults in care.
Collapse
|
8
|
Adlbrecht L, Nemeth T, Frommlet F, Bartholomeyczik S, Mayer H. Engagement in purposeful activities and social interactions amongst persons with dementia in special care units compared to traditional nursing homes: An observational study. Scand J Caring Sci 2021; 36:650-662. [PMID: 34291489 PMCID: PMC9540018 DOI: 10.1111/scs.13017] [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: 12/22/2020] [Revised: 06/05/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
Background Persons with dementia spend most time of their day not engaging in activities or social interactions. A care concept of a dementia special care unit that promotes activities and social interaction through a household‐like design and individualised stimuli is studied. Aim To evaluate the main outcomes of the care concept of a dementia special care unit, namely, engagement in activities and social interactions. Methods We conducted an observational study as part of a theory‐driven evaluation. The Maastricht Daily Life Observation Tool was used to collect momentary assessments multiple times per participant, including engagement in activity, type of activity, engagement in social interaction, interaction partners, location, agitation and mood. Thirty‐three residents of the dementia special care units that implemented the care concept and 54 residents with dementia of two traditional nursing homes participated in the study, resulting in 2989 momentary assessments. Results Residents of both settings did not engage in activities or social interaction in approximately half of the observations. Compared to residents of traditional nursing homes, residents of special care units had a significantly higher chance for engagement in activities and social interaction in the afternoon but not in the morning or evening. Conclusion The care concept of the special care unit facilitated engagement but had its limitations. Further research is needed to develop and evaluate appropriate interventions to enhance engagement of persons with dementia.
Collapse
Affiliation(s)
- Laura Adlbrecht
- Department of Nursing Science, Faculty of Social Sciences, University of Vienna, Vienna, Austria.,Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, FHS St. Gallen, University of Applied Sciences, St. Gallen, Switzerland
| | - Tamara Nemeth
- Department of Nursing Science, Faculty of Social Sciences, University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | | | - Hanna Mayer
- Department of Nursing Science, Faculty of Social Sciences, University of Vienna, Vienna, Austria
| |
Collapse
|
9
|
Luscombe N, Morgan-Trimmer S, Savage S, Allan L. Digital technologies to support people living with dementia in the care home setting to engage in meaningful occupations: protocol for a scoping review. Syst Rev 2021; 10:179. [PMID: 34148547 PMCID: PMC8214930 DOI: 10.1186/s13643-021-01715-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 05/19/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND People living with all stages of dementia should have the opportunity to participate in meaningful occupations. For those living in care homes, this may not always occur and residents may spend significant parts of the day unengaged, especially those living with more advanced dementia. Digital technologies are increasingly being used in health care and could provide opportunities for people living with dementia (PLWD) in care homes to engage in meaningful occupations and support care staff to provide these activities. With technology advancing at a rapid rate, the objective of this scoping review is to provide an up-to-date systematic map of the research on the diverse range of digital technologies that support engagement in meaningful occupations. In particular, focus will be given to barriers and facilitators to inform future intervention design and implementation strategies, which have not yet been clearly mapped across the full range of these digital technologies. METHOD A scoping review will be conducted to systematically search for published research using a comprehensive search strategy on thirteen databases. Published, peer-reviewed studies that focused on PLWD in the care home setting and assessed any form of digital technology that supported a meaningful occupation will be included. All methodologies which meet the criteria will be included. Data will be extracted and charted to report the range of digital technologies, underlying mechanisms of action, facilitators and barriers to implementation. DISCUSSION Mapping the range of technologies to support PLWD to engage in meaningful occupations will identify gaps in research. The systematic search will include a diverse range of technologies such as software to enhance care planning, tablets devices, smartphones, communication robots and social media platforms, rather than focussing on a specific design or interface. This will enable comparison between mechanisms of action, barriers and facilitators to implementation which will be useful for future research and intervention design. TRIAL REGISTRATION Open Science Framework https://doi.org/10.17605/OSF.IO/7UDM2.
Collapse
Affiliation(s)
- Nicholas Luscombe
- The Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter Medical School, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Sarah Morgan-Trimmer
- Institute of Health Research, College House, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sharon Savage
- School of Psychology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Louise Allan
- The Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter Medical School, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| |
Collapse
|
10
|
Thodberg K, Videbech PB, Hansen TGB, Pedersen AB, Christensen JW. Dog visits in nursing homes - increase complexity or keep it simple? A randomised controlled study. PLoS One 2021; 16:e0251571. [PMID: 34038451 PMCID: PMC8153477 DOI: 10.1371/journal.pone.0251571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the immediate response of nursing home residents to dog visits with or without an activity, and the impact of cognitive ability. Methods In a randomly controlled trial, 174 nursing home residents were allocated to 12 bi-weekly 10-minute visits: either ordinary dog visits (D, n = 57, 49 analysed), dog visits with an activity (DA, n = 56, 48 analysed), or visits with activity but no dog (A, n = 61, 54 analysed). We recorded frequency and duration of residents’ verbal and physical interactions with the dog and persons. Data were analysed in three periods of four visits (period 1–3) as binomial variables (generalised linear models) or durations (non-parametric statistics). Results Both visit type and impairment level affected the likelihood of interacting with the dog (D and DA). In some periods increased cognitive impairment lowered odds of touching the dog in DA visits (period 1: F1,85 = 5.17, P < 0.05) and talking to it directly (period 1: F1,90 = 4.60, P < 0.05; period 3: F1,87 = 5.34, P < 0.05). Throughout, residents talked less to persons during DA visits compared to D and A (P = 0.01–0.05), and level of cognitive impairment correlated negatively with talk duration (P < 0.001). Generally, high cognitive impairment level lowered odds of interacting with (period 1: F1,89 = 7.89, P < 0.01; period 2: F1,97 = 6.76, P = 0.01; period 3: F1,92 = 13.57, P < 0.001) and talking about the activities (period 1: F1,89 = 13.78, P <0.001; period 2: F1,88 = 3.27, P = 0.07; period 3: F1,86 = 3.88, P = 0.05). Conclusion Visits without specific activities stimulated residents to interact with the dog, whereas increasing the complexity of dog visits by adding activities resulted in less interaction with the dog for severely impaired residents. The optimal dog visit for the less cognitively impaired residents could include activities and thereby a possibility to interact with the dog in different ways, whereas for severely impaired residents, just being with the dog seems more appropriate.
Collapse
Affiliation(s)
- Karen Thodberg
- Department of Animal Science, Aarhus University, Aarhus, Denmark
- * E-mail:
| | | | - Tia G. B. Hansen
- Center for Developmental and Applied Psychological Science, Aalborg University, Aalborg, Denmark
| | | | | |
Collapse
|
11
|
Casey D, Barrett E, Kovacic T, Sancarlo D, Ricciardi F, Murphy K, Koumpis A, Santorelli A, Gallagher N, Whelan S. The Perceptions of People with Dementia and Key Stakeholders Regarding the Use and Impact of the Social Robot MARIO. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8621. [PMID: 33233605 PMCID: PMC7699754 DOI: 10.3390/ijerph17228621] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022]
Abstract
People with dementia often experience loneliness and social isolation. This can result in increased cognitive decline which, in turn, has a negative impact on quality of life. This paper explores the use of the social robot, MARIO, with older people living with dementia as a way of addressing these issues. A descriptive qualitative study was conducted to explore the perceptions and experiences of the use and impact of MARIO. The research took place in the UK, Italy and Ireland. Semi-structured interviews were held in each location with people with dementia (n = 38), relatives/carers (n = 28), formal carers (n = 28) and managers (n = 13). The data was analyzed using qualitative content analysis. The findings revealed that despite challenges in relation to voice recognition and the practicalities of conducting research involving robots in real-life settings, most participants were positive about MARIO. Through the robot's user-led design and personalized applications, MARIO provided a point of interest, social activities, and cognitive engagement increased. However, some formal carers and managers voiced concern that robots might replace care staff.
Collapse
Affiliation(s)
- Dympna Casey
- School of Nursing and Midwifery, Aras Moyola, NUI, Galway, Ireland; (K.M.); (N.G.); (S.W.)
| | - Eva Barrett
- College of Engineering and Science, Alice Perry Building, NUI, Galway, Ireland;
| | - Tanja Kovacic
- UNESCO Child and Family Research Centre, School of Political Science and Sociology, NUI, Galway, Ireland;
| | - Daniele Sancarlo
- Sistemi Informativi, Innovazione e Ricerca, IRCCS Casa Sollievo della Sofferenza. Viale Cappuccini, 1 71013 San Giovanni Rotondo FG, Italy; (D.S.); (F.R.)
| | - Francesco Ricciardi
- Sistemi Informativi, Innovazione e Ricerca, IRCCS Casa Sollievo della Sofferenza. Viale Cappuccini, 1 71013 San Giovanni Rotondo FG, Italy; (D.S.); (F.R.)
| | - Kathy Murphy
- School of Nursing and Midwifery, Aras Moyola, NUI, Galway, Ireland; (K.M.); (N.G.); (S.W.)
| | - Adamantios Koumpis
- Institut Digital Enabling, Berner Fachhochschule, CH-3012 Bern, Switzerland;
| | - Adam Santorelli
- Faculty of Engineering, Macdonald Engineering Building, 817 Sherbrooke Street West, Room 382 Montreal, Montreal, QC H3A 0C3, Canada;
| | - Niamh Gallagher
- School of Nursing and Midwifery, Aras Moyola, NUI, Galway, Ireland; (K.M.); (N.G.); (S.W.)
| | - Sally Whelan
- School of Nursing and Midwifery, Aras Moyola, NUI, Galway, Ireland; (K.M.); (N.G.); (S.W.)
| |
Collapse
|
12
|
Renom A, Möhler R, Renom H, Meyer G. Personally-tailored activities for improving psychosocial outcomes for people with dementia in community settings. Hippokratia 2020. [DOI: 10.1002/14651858.cd010515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Renom
- School of Nursing Science, Faculty of Health; Witten/Herdecke University; Witten Germany
| | - Ralph Möhler
- School of Nursing Science, Faculty of Health; Witten/Herdecke University; Witten Germany
| | - Helena Renom
- Physical Medicine and Rehabilitation (MFRHB); Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - Gabriele Meyer
- School of Nursing Science, Faculty of Health; Witten/Herdecke University; Witten Germany
| |
Collapse
|
13
|
Barrett E, Burke M, Whelan S, Santorelli A, Oliveira BL, Cavallo F, Dröes RM, Hopper L, Fawcett-Henesy A, Meiland FJM, Mountain G, Moyle W, Raciti M, Pegman G, Teare A, Sancarlo D, Riccardi F, D'Onofrio G, Giuliani F, Russo A, Bleaden A, Greco A, Casey D. Evaluation of a Companion Robot for Individuals With Dementia: Quantitative Findings of the MARIO Project in an Irish Residential Care Setting. J Gerontol Nurs 2020; 45:36-45. [PMID: 31237660 DOI: 10.3928/00989134-20190531-01] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/14/2019] [Indexed: 11/20/2022]
Abstract
The current study focuses on the short-term effect of MARIO, a social robot, on quality of life, depression, and perceived social support in persons with dementia (PWD) and evaluates their acceptability of MARIO. Ten PWD in one nursing home took part in a 4-week pilot study, where each participant had up to 12 sessions with MARIO. Sessions comprised engagement in music, news, reminiscence, games, and calendar applications. Standardized questionnaires were administered before and after the 4-week period. Participants had a sustained interest in MARIO during their interactions and an acceptance of MARIO's appearance, sound, and applications. Consequently, participants spent more time socially engaged. No statistically significant differences were found in quality of life, depression, and perceived social support. PWD can engage with a social robot in a real-world nursing home. Future research should incorporate a larger sample and longer intervention period. [Journal of Gerontological Nursing, 45(7), 36-45.].
Collapse
|
14
|
Plys E, Qualls SH. Programmed Activity Offerings and Attendance Patterns in Assisted Living. ACTIVITIES, ADAPTATION & AGING 2020; 45:276-288. [PMID: 34898777 PMCID: PMC8654323 DOI: 10.1080/01924788.2020.1773674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/11/2020] [Indexed: 06/14/2023]
Abstract
The scope of programmed activity offerings and attendance rates for specific activities are not thoroughly captured in the assisted living (AL) literature. The purpose of this study is to report activity offerings and associated attendance rates, as well as relationships between individual factors and activity attendance patterns in a sample of 202 residents of 21 ALs. Sampled communities offered 50 different types of programmed activities. Each AL offered exercise and religious services, most offered BINGO (n = 19, 91%) and socials (n = 18, 86%). BINGO was the most frequently attended activity (n = 83; 47%), followed by religious services (n = 75; 38%), socials (n = 67; 40%), and musical performances (n = 62, 37%). Additional findings provide insight into the features of frequently attended activities, and the relationships between attendance and resident characteristics. The authors conclude with a discussion of implications for service delivery and future research.
Collapse
Affiliation(s)
- Evan Plys
- General Internal Medicine, University of Colorado Denver-Anschutz Medical Campus
- Department of Psychology, University of Colorado Colorado Springs
| | - Sara H. Qualls
- Department of Psychology, University of Colorado Colorado Springs
- Gerontology Center, University of Colorado Colorado Springs
| |
Collapse
|
15
|
Boumans J, van Boekel LC, Baan CA, Luijkx KG. How Can Autonomy Be Maintained and Informal Care Improved for People With Dementia Living in Residential Care Facilities: A Systematic Literature Review. THE GERONTOLOGIST 2020; 59:e709-e730. [PMID: 30239712 PMCID: PMC6858830 DOI: 10.1093/geront/gny096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives For people with dementia living in residential care facilities, maintaining autonomy and receiving informal care are important. The objective of this review is to understand how caregiving approaches and physical environment, including technologies contribute to the maintenance of autonomy and informal care provision for this population. Research Design and Methods A literature review of peer-reviewed articles published between January 1995 and July 2017 was performed. Realist logic of analysis was used, involving context, mechanism and outcome configurations. Results Forty-nine articles were included. The improvement of the relationship between residents and formal/informal caregivers is important. This increases the knowledge (sharing) about the resident and contributes to their autonomy. A social, flexible, and welcoming attitude of the formal caregiver improves the provision of informal care. Specially designed spaces, for instance, therapeutic gardens, create activities for residents that remind them of themselves and contribute to their autonomy. Use of technologies reduces caregiver’s time for primary tasks and therefore enables secondary tasks such as interaction with the residents. Discussion and Implications The results revealed how residential care facilities could maintain autonomy of their residents and improve informal care delivery using caregiving approaches and the physical environment including technologies. The results are supporting toward each other in maintaining autonomy and also helped in enhancing informal care provision. For residential care facilities that want to maintain the autonomy of their residents and improve informal care delivery, it is important to pay attention to all aspects of living in a residential care facility.
Collapse
Affiliation(s)
- Jogé Boumans
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| | - Leonieke C van Boekel
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| | - Caroline A Baan
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands.,Department of Quality of Care and Health Economics, Centre for Nutrition, Prevent and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Katrien G Luijkx
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| |
Collapse
|
16
|
Plys E. Recreational Activity in Assisted Living Communities: A Critical Review and Theoretical Model. THE GERONTOLOGIST 2020; 59:e207-e222. [PMID: 31099851 DOI: 10.1093/geront/gnx138] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This paper critically reviewed the scientific literature on recreational activity (RA) behaviors in assisted living (AL) communities. RESEARCH DESIGN AND METHODS A search of three databases yielded 70 quantitative, qualitative, and observational articles that met criteria for inclusion. RESULTS AL residents participated in various types of RA, however, did so infrequently. Individual, interindividual, environmental, and relocation factors influenced RA behaviors, and participation may relate to positive consequences for residents and AL communities. This review identified multiple limitations in the literature related to construct definitions, measurement protocols, and incomplete or absent theoretical frameworks. DISCUSSION AND IMPLICATIONS To address these limitations, the current review proposes a multivariate measurement model and an interdisciplinary theoretical model of factors relating to RA, consistent with an ecological framework. The proposed models appreciate individual psychological factors that influence the multiple facets of human choice and behavior, as well as the interaction between individuals and the unique sociophysical environment of AL. This paper concludes with recommendations for future research, emphasizing studies that have applied implications for practice and policy.
Collapse
Affiliation(s)
- Evan Plys
- Department of Psychology, University of Colorado at Colorado Springs
| |
Collapse
|
17
|
O'Caoimh R, O'Donovan MR, Monahan MP, Dalton O'Connor C, Buckley C, Kilty C, Fitzgerald S, Hartigan I, Cornally N. Psychosocial Impact of COVID-19 Nursing Home Restrictions on Visitors of Residents With Cognitive Impairment: A Cross-Sectional Study as Part of the Engaging Remotely in Care (ERiC) Project. Front Psychiatry 2020; 11:585373. [PMID: 33192731 PMCID: PMC7649131 DOI: 10.3389/fpsyt.2020.585373] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/25/2020] [Indexed: 01/10/2023] Open
Abstract
Background: COVID-19 has disproportionately affected older people. Visiting restrictions introduced since the start of the pandemic in residential care facilities (RCFs) may impact negatively on visitors including close family, friends, and guardians. We examined the effects of COVID-19 visiting restrictions on measures of perceived loneliness, well-being, and carer quality of life (QoL) amongst visitors of residents with and without cognitive impairment (CI) in Irish RCFs. Methods: We created a cross-sectional online survey. Loneliness was measured with the UCLA brief loneliness scale, psychological well-being with the WHO-5 Well-being Index and carer QoL with the Adult Carer QoL Questionnaire (support for caring subscale). Satisfaction with care ("increased/same" and "decreased") was measured. A history of CI was reported by respondents. Sampling was by convenience with the link circulated through university mail lists and targeted social media accounts for 2 weeks in June 2020. Results: In all, 225 responses were included of which 202 noted whether residents had reported CI. Most of the 202 identified themselves as immediate family (91%) and as female (82%). The majority (67%) were aged between 45 and 64 years. Most (80%) reported that their resident had CI. Approximately one-third indicated reduced satisfaction (27%) or that restrictions had impaired communication with nursing home staff (38%). Median loneliness scores were 4/9, well-being scores 60/100 and carer QoL scores 10/15. Visitors of those with CI reported significantly lower well-being (p = 0.006) but no difference in loneliness (p = 0.114) or QoL (p = 0.305). Reported CI (p = 0.04) remained an independent predictors of lower WHO-5 scores, after adjusting for age, sex, RCF location, and dementia stage (advanced), satisfaction with care (reduced), and perception of staff support measured on the Adult Carer QoL Questionnaire. Conclusion: This survey suggests that many RCF visitors experienced low psychosocial and emotional well-being during the COVID-19 lockdown. Visitors of residents with CI report significantly poorer well-being as measured by the WHO-5 than those without. Additional research is required to understand the importance of disrupted caregiving roles resulting from visiting restrictions on well-being, particularly on visitors of residents with CI and how RCFs and their staff can support visitors to mitigate these.
Collapse
Affiliation(s)
- Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Mark R O'Donovan
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Margaret P Monahan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Catherine Buckley
- Northridge House Education and Research Centre, St. Lukes Home, Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Serena Fitzgerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| |
Collapse
|
18
|
Klatt BN, Ries JD, Dunlap PM, Whitney SL, Agrawal Y. Vestibular Physical Therapy in Individuals With Cognitive Impairment: A Theoretical Framework. J Neurol Phys Ther 2019; 43 Suppl 2:S14-S19. [PMID: 30883488 DOI: 10.1097/npt.0000000000000266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Falls are a major health care concern in individuals with Alzheimer disease (AD) and their caregivers. Vestibular impairment is a known risk factor for falls, and individuals with AD have been shown to have an increased prevalence of vestibular loss compared with age-matched controls. Vestibular physical therapy (VPT) is effective in improving balance and reducing fall risk in cognitively-intact persons with vestibular impairment. However, the effectiveness of VPT in improving balance and reducing falls in individuals with AD who have vestibular loss has never been explored. SUMMARY OF KEY POINTS:: In this article, we apply prevailing ideas about rehabilitation and motor learning in individuals with cognitive impairment (IwCI) to VPT. RECOMMENDATIONS FOR CLINICAL PRACTICE:: We propose a modification of current evidence-based VPT protocols for IwCI using the strength-based theoretical framework that emphasizes the motor learning abilities of IwCI. In addition, we highlight the importance of establishing an excellent rapport with IwCI, and present key strategies for optimizing the therapeutic relationship. In ongoing work, we are assessing the efficacy of this modified VPT protocol in IwCI to improve balance and reduce falls.
Collapse
Affiliation(s)
- Brooke N Klatt
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland (B.N.K., Y.A.); Department of Physical Therapy, Marymount University, Arlington, Virginia (J.D.R.); and Department of Physical Therapy, University of Pittsburgh, Pennsylvania (P.M.D., S.L.W.)
| | | | | | | | | |
Collapse
|
19
|
Fast CT, Houlihan D, Buchanan JA. Developing the Family Involvement Questionnaire-Long-Term Care: A Measure of Familial Involvement in the Lives of Residents at Long-Term Care Facilities. THE GERONTOLOGIST 2019; 59:e52-e65. [PMID: 29304241 DOI: 10.1093/geront/gnx197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Existing measures designed to assess family involvement in the lives of older adults residing in long-term care facilities are basic, using visitation frequency as the prominent gauge of involvement in a situation specific fashion. The purpose of this study was to design and validate a measure of family involvement that could be used to gauge more aspects of family involvement than visitation alone and be useful in a variety of settings for both researchers and long-term care facility administrators. METHODS Long-term facility staff were asked to assist in creating a 40-item questionnaire that used 4-point Likert scales to measure various aspects of family involvement. The finalized Family Involvement Questionnaire-Long-Term Care (FIQ-LTC) was distributed to the family members of older adults residing in long-term care facilities around the country. RESULTS A total of 410 participants responded. Researchers found that the FIQ-LTC was highly reliable (α = .965). Results also indicated that a significant correlation between distance and overall involvement (r = -.121, p = .015) was no longer significant (r = .17, p = .740) when the effect of a question asking the frequency of visitation was controlled for. DISCUSSION These results indicate that existing measures that use visitation frequency as the sole measure of involvement are insufficient. The newly developed FIQ-LTC can serve as a more complete measure of family involvement.
Collapse
Affiliation(s)
| | - Daniel Houlihan
- Department of Psychology, Minnesota State University, Mankato
| | | |
Collapse
|
20
|
Sengupta M, Zimmerman S, Harris-Kojetin L. Activity Engagement in Residential Care Settings: Findings from the National Survey of Residential Care Facilities. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/02763893.2018.1534178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Manisha Sengupta
- National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Sheryl Zimmerman
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | |
Collapse
|
21
|
Möhler R, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care. Cochrane Database Syst Rev 2018; 2:CD009812. [PMID: 29438597 PMCID: PMC6491165 DOI: 10.1002/14651858.cd009812.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND People with dementia who are being cared for in long-term care settings are often not engaged in meaningful activities. Offering them activities which are tailored to their individual interests and preferences might improve their quality of life and reduce challenging behaviour. OBJECTIVES ∙ To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in long-term care facilities.∙ To describe the components of the interventions.∙ To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, on 16 June 2017 using the terms: personally tailored OR individualized OR individualised OR individual OR person-centred OR meaningful OR personhood OR involvement OR engagement OR engaging OR identity. We also performed additional searches in MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science (ISI Web of Science), ClinicalTrials.gov, and the World Health Organization (WHO) ICTRP, to ensure that the search for the review was as up to date and as comprehensive as possible. SELECTION CRITERIA We included randomised controlled trials and controlled clinical trials offering personally tailored activities. All interventions included an assessment of the participants' present or past preferences for, or interests in, particular activities as a basis for an individual activity plan. Control groups received either usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two authors independently checked the articles for inclusion, extracted data and assessed the methodological quality of included studies. For all studies, we assessed the risk of selection bias, performance bias, attrition bias and detection bias. In case of missing information, we contacted the study authors. MAIN RESULTS We included eight studies with 957 participants. The mean age of participants in the studies ranged from 78 to 88 years and in seven studies the mean MMSE score was 12 or lower. Seven studies were randomised controlled trials (three individually randomised, parallel group studies, one individually randomised cross-over study and three cluster-randomised trials) and one study was a non-randomised clinical trial. Five studies included a control group receiving usual care, two studies an active control intervention (activities which were not personally tailored) and one study included both an active control and usual care. Personally tailored activities were mainly delivered directly to the participants; in one study the nursing staff were trained to deliver the activities. The selection of activities was based on different theoretical models but the activities did not vary substantially.We found low-quality evidence indicating that personally tailored activities may slightly improve challenging behaviour (standardised mean difference (SMD) -0.21, 95% confidence interval (CI) -0.49 to 0.08; I² = 50%; 6 studies; 439 participants). We also found low-quality evidence from one study that was not included in the meta-analysis, indicating that personally tailored activities may make little or no difference to general restlessness, aggression, uncooperative behaviour, very negative and negative verbal behaviour (180 participants). There was very little evidence related to our other primary outcome of quality of life, which was assessed in only one study. From this study, we found that quality of life rated by proxies was slightly worse in the group receiving personally tailored activities (moderate-quality evidence, mean difference (MD) -1.93, 95% CI -3.63 to -0.23; 139 participants). Self-rated quality of life was only available for a small number of participants, and there was little or no difference between personally tailored activities and usual care on this outcome (low-quality evidence, MD 0.26, 95% CI -3.04 to 3.56; 42 participants). We found low-quality evidence that personally tailored activities may make little or no difference to negative affect (SMD -0.02, 95% CI -0.19 to 0.14; I² = 0%; 6 studies; 589 participants). We found very low quality evidence and are therefore very uncertain whether personally tailored activities have any effect on positive affect (SMD 0.88, 95% CI 0.43 to 1.32; I² = 80%; 6 studies; 498 participants); or mood (SMD -0.02, 95% CI -0.27 to 0.23; I² = 0%; 3 studies; 247 participants). We were not able to undertake a meta-analysis for engagement and the sleep-related outcomes. We found very low quality evidence and are therefore very uncertain whether personally tailored activities improve engagement or sleep-related outcomes (176 and 139 participants, respectively). Two studies that investigated the duration of the effects of personally tailored activities indicated that the intervention effects persisted only during the delivery of the activities. Two studies reported information about adverse effects and no adverse effects were observed. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia in long-term care may slightly improve challenging behaviour. Evidence from one study suggested that it was probably associated with a slight reduction in the quality of life rated by proxies, but may have little or no effect on self-rated quality of life. We acknowledge concerns about the validity of proxy ratings of quality of life in severe dementia. Personally tailored activities may have little or no effect on negative affect and we are uncertain whether they improve positive affect or mood. There was no evidence that interventions were more likely to be effective if based on one specific theoretical model rather than another. Our findings leave us unable to make recommendations about specific activities or the frequency and duration of delivery. Further research should focus on methods for selecting appropriate and meaningful activities for people in different stages of dementia.
Collapse
Affiliation(s)
- Ralph Möhler
- Medical Center, Faculty of Medicine, University of FreiburgInstitute for Evidence in Medicine (for Cochrane Germany Foundation)Breisacher Str. 153FreiburgGermany79110
| | - Anna Renom
- Parc de Salut MarDepartment of GeriatricsCarrer Llull, 410BarcelonaSpain08019
| | - Helena Renom
- Hospital de la Santa Creu i Sant PauPhysical Medicine and Rehabilitation (MFRHB)Carrer Sant Antoni Maria Claret, 167BarcelonaBarcelonaSpain08025
| | - Gabriele Meyer
- Martin Luther University Halle‐WittenbergInstitute of Health and Nursing SciencesMagdeburger Straße 8Halle (Saale)Germany06112
| | | |
Collapse
|
22
|
Smit D, de Lange J, Willemse B, Pot AM. Predictors of activity involvement in dementia care homes: a cross-sectional study. BMC Geriatr 2017; 17:175. [PMID: 28778153 PMCID: PMC5545000 DOI: 10.1186/s12877-017-0564-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 07/24/2017] [Indexed: 11/13/2022] Open
Abstract
Background Despite the finding that involvement in activities is one of the most important needs of residents with dementia living in care homes, care facilities struggle to fulfill this need. Over the years, various factors are suggested which may contribute to or disable activity provision in dementia care homes. These include limited financial resources, task oriented staff and disease-related characteristics of residents. This study aims to further clarify which of these factors predict higher activity involvement. Methods Data were derived from the second measurement (2011) of the Living Arrangements for people with Dementia study. One thousand two hundred eighteen people residing in 139 dementia care homes were involved. Forty predictors of higher involvement were studied. Multilevel backward regression analyses were performed. Results The most important predictors of higher involvement were: absence of agitation, less ADL dependency, and a higher cognitive status of the residents, higher staff educational level, lower experienced job demands by care staff and a smaller number of residents living in the dementia care wards of a facility. More social supervisor support as perceived by staff was found to predict less activity involvement. Conclusions To increase the activity involvement of care home residents with dementia it seems vital to: 1) reduce staff’s experienced job demands; 2) elevate their overall educational level; 3) train staff to provide suitable activities, taking account of the behavior and preserved capabilities of residents; and 4) foster transition towards small-scale care. In order to achieve these aims, care organizations might need to evaluate the use of their financial means. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0564-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Dieneke Smit
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands. .,Program on Aging, Netherlands Institute of Mental Health and Addiction, PO box 725, 3500 AS, Utrecht, the Netherlands.
| | - Jacomine de Lange
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, the Netherlands
| | - Bernadette Willemse
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.,Program on Aging, Netherlands Institute of Mental Health and Addiction, PO box 725, 3500 AS, Utrecht, the Netherlands
| | - Anne Margriet Pot
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.,Program on Aging, Netherlands Institute of Mental Health and Addiction, PO box 725, 3500 AS, Utrecht, the Netherlands.,School of Psychology, University of Queensland, Brisbane, Australia
| |
Collapse
|
23
|
How do staff influence the quality of long-term dementia care and the lives of residents? A systematic review of the evidence. Int Psychogeriatr 2016; 28:1263-81. [PMID: 27082717 DOI: 10.1017/s1041610216000570] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Research suggests and common sense indicates that there are relationships between staff variables in residential dementia care and the quality of life (QOL) of residents, with poor care due to staff factors increasing resident suffering. Despite these indications, we do not have a coherent picture of these relationships, which variables are important, and where to intervene in order to minimize suffering for people with dementia. METHODS This systematic review examined associations between staff variables, quality of care (QOC), and QOL for residents, using published peer-reviewed literature from the last 20 years. A comprehensive search was conducted using an exhaustive list of search terms, leading to the identification of 33,204 unique papers, which was reduced to 35 on-topic papers. RESULTS In the main, we were able to provide collective evidence to suggest there are relationships between potentially adjustable staff variables and QOC on to QOL. When staff treat and interact empathetically and humanely in care, there is a relationship with better mood for residents, delayed functional dependence and better food intake. Where staff are more skilled and educated, there is less psychotropic medication use. Unlimited empathy about the risk of residents falling or being in pain is not enough; staff need to know about the dangers of restraint. CONCLUSIONS Confidence in these indicative links is weakened by a lack of high-quality prospective longitudinal studies focusing on potentially adjustable staff variables, with a bias towards cross-sectional studies including only variables that are fixed or unlikely to change. (Review registration no. PROSPERO 2014:CRD42014015224).
Collapse
|
24
|
Gräske J, Meyer S, Worch A, Wolf-Ostermann K. Family visits in shared-housing arrangements for residents with dementia--a cross-sectional study on the impact on residents' quality of life. BMC Geriatr 2015; 15:14. [PMID: 25868401 PMCID: PMC4347913 DOI: 10.1186/s12877-015-0012-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 02/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shared-housing arrangements (SHA) are a German type of small-scale living arrangements for people with dementia (PwD). The involvement of family members is one core domain of SHA. But it has not been investigated yet, what are factors associated with family visits and if family involvement within SHA contributes to better residents' quality of life (QoL). METHOD A cross-sectional study including all SHA in Berlin/Germany was performed. Main parameters of interest were residents' QoL (QUALIDEM) and frequencies of family visits within the SHA. Besides descriptive analyses we used logistic regression and ANCOVA to analyze the data. RESULTS 58 SHA with 396 residents (78.4 years, 69.4% female) participated in the study. Older (OR: 1.034; 95% CI: 1.005; 1.064) and female residents (OR: 2.006; 95% CI: 1.018; 3.950) got more often visited by family members. An active participation of family members in SHA contributes on average to a better QoL in terms of social relationship and social isolation (all ANCOVA p < 0.005). A decreased QoL was found for people without family visits compared to those without family members. CONCLUSIONS The involvement of family members in SHA is common but on a similar level compared to other care arrangements. Staff should convince available family members to visit PwD, in order to improve residents QoL. However, the response rate in the present study was about 13%, which may limit the results.
Collapse
Affiliation(s)
- Johannes Gräske
- Department 11: Human and Health Sciences, University of Bremen, PF 330440, 28334 Bremen, Germany
| | - Saskia Meyer
- Department 11: Human and Health Sciences, University of Bremen, PF 330440, 28334 Bremen, Germany
| | - Andreas Worch
- Department 11: Human and Health Sciences, University of Bremen, PF 330440, 28334 Bremen, Germany
| | - Karin Wolf-Ostermann
- Department 11: Human and Health Sciences, University of Bremen, PF 330440, 28334 Bremen, Germany
| |
Collapse
|
25
|
Cohen LW, Zimmerman S, Reed D, Sloane PD, Beeber AS, Washington T, Cagle JG, Gwyther LP. Dementia in relation to family caregiver involvement and burden in long-term care. J Appl Gerontol 2014; 33:522-40. [PMID: 24652906 PMCID: PMC3989456 DOI: 10.1177/0733464813505701] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
To better understand the process and outcomes of family involvement for long-term care residents with varying stages of dementia, we analyzed family and staff data for 467 residents of 24 residential care/assisted living and nursing-home settings. Adjusted analyses found that although the amount of family visitation did not significantly vary by resident cognitive status (15 versus 20 visits/month to persons with and without dementia, respectively), the nature of the visit did. Families of cognitively intact residents spent more time in activities related to social and community engagement, such as taking residents on trips and calling and writing letters (p<.001), while families of more impaired residents spent more time on care-related activities, including tasks related to nutrition (p<.027), mobility (p=.001), and discussing care with staff (p=.007), the latter of which was associated with greater burden (p<.001). Staff identified similar patterns but perceived less family involvement.
Collapse
Affiliation(s)
- Lauren W Cohen
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David Reed
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip D Sloane
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna S Beeber
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - John G Cagle
- University of Maryland, Baltimore, Baltimore, MD, USA
| | | |
Collapse
|
26
|
Helgesen AK, Athlin E, Larsson M. Relatives’ participation in everyday care in special care units for persons with dementia. Nurs Ethics 2014; 22:404-16. [DOI: 10.1177/0969733014538886] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Research concerning relatives’ participation in the everyday care related to persons living in special care units for persons with dementia is limited. Research questions: To examine relatives’ participation in their near one’s everyday care, the level of burden experienced and important factors for participation, in this special context. Design: The study had a cross-sectional design, and data collection was carried out by means of a study-specific questionnaire. Participants and context: A total of 233 relatives from 23 different special care units participated. Ethical consideration: The study was approved by the Norwegian Social Science Data Services. Results: A great majority of relatives reported that they visited weekly and were the resident’s spokesperson, but seldom really participated in decisions concerning their everyday care. Participation was seldom reported as a burden. Discussion: This study indicated that relatives were able to make a difference to their near one’s everyday life and ensure quality of care based on their biographical expertise, intimate knowledge about and emotional bond with the resident. Since knowing the resident is a prerequisite for providing individualised care that is in line with the resident’s preferences, information concerning these issues is of utmost importance. Conclusion: This study prompts reflection about what it is to be a spokesperson and whether everyday care is neglected in this role. Even though relatives were satisfied with the care provided, half of them perceived their participation as crucial for the resident’s well-being. This indicated that relatives were able to offer important extras due to their biographical expertise, intimate knowledge about and emotional bond with the resident. Good routines securing that written information about the residents’ life history and preferences is available and used should be implemented in practice.
Collapse
|
27
|
Wellbeing-enhancing occupation and organizational and environmental contributors in long-term dementia care facilities: an explorative study. Int Psychogeriatr 2014; 26:69-80. [PMID: 24053758 DOI: 10.1017/s1041610213001397] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Occupation remains an unmet need in long-term dementia care. To increase residents' occupation, knowledge of types of occupation related to wellbeing, and organizational and environmental characteristics encouraging involvement in these types of occupation, is indispensable. METHODS In this explorative study, Dementia Care Mapping was used to study involvement in different types of occupation and wellbeing among 57 residents of 10 dementia care facilities. For each type of occupation, mean experienced wellbeing was studied. Occupation types with high mean wellbeing scores were classified as "wellbeing-enhancing occupation." Care facilities were ranked according to the mean time residents spent in types of wellbeing-enhancing occupation. Using information on staff-to-resident ratio, individual space, and items of the Physical Environment Evaluation Component of Dementia Care Mapping, organizational and environmental characteristics of the facilities were compared to study their relationship with wellbeing-enhancing occupation. RESULTS Reminiscence, leisure, expression, and vocational occupation had greatest potential to enhance wellbeing, but these types were seldom offered. Much variation existed in the extent to which wellbeing-enhancing occupation was provided. Long-term care facilities that did so more frequently generally had a more homelike atmosphere, supported social interaction through the environment, and had no central activity program. CONCLUSIONS This study suggests that it is possible to engage residents in wellbeing-enhancing occupation, within current means of budget and staff. The physical environment and care organization might play a role, but the key factor seems to equip staff with skills to integrate wellbeing-enhancing occupation into care practice.
Collapse
|
28
|
Cadieux MA, Garcia LJ, Patrick J. Needs of people with dementia in long-term care: a systematic review. Am J Alzheimers Dis Other Demen 2013; 28:723-33. [PMID: 24005852 PMCID: PMC10852926 DOI: 10.1177/1533317513500840] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
With the aging of the population and the projected increase of dementia in the coming years, it is crucial that we understand the needs of people with dementia (PWD) in order to provide appropriate care. The aim of this study is to determine, using the best evidence possible, the care needs of PWD living in long-term care (LTC). A total of 68 studies, published between January 2000 and September 2010, were identified from six databases. From the selected studies, 19 needs of PWD were identified. The existing evidence suggests that psychosocial needs such as the need to engage in daily individualized activities and care must not be ignored in LTC. This review aims to provide a clearer picture of the needs of this growing patient population.
Collapse
Affiliation(s)
- Marie-Andrée Cadieux
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda J. Garcia
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Jonathan Patrick
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
29
|
DiBartolo MC, Vozzella SM, Rebert AN. The club concept: targeting behavioral issues in a residential setting for cognitively impaired adults. J Gerontol Nurs 2013; 39:46-51. [PMID: 23855326 DOI: 10.3928/00989134-20130627-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 02/14/2013] [Indexed: 12/22/2022]
Abstract
Behavior and psychological symptoms of dementia are common in residential care facilities. These symptoms not only detract from the quality of life of the resident with dementia, but they can be disruptive to the unit and result in harm to staff and other residents. With the trend away from pharmacological management, other creative psychosocial-environmental strategies are being explored. One innovative approach involves the use of the club concept, where selected agitated residents spend a portion of the day in a separate structured environment. This program combines trained staff and tailored activities that optimize mental stimulation, functional independence, and self-esteem. Benefits include reduced incidents of aggressive behaviors and use of psychoactive medications, as well as enhanced quality of life. Not only do the participants benefit from time spent in this specialized setting, but the therapeutic milieu of the facility is also enhanced. Further evaluation of such strategies is needed to quantify the benefits of targeted behavioral interventions for those with cognitive impairment.
Collapse
|
30
|
Cruz J, Marques A, Barbosa A, Figueiredo D, Sousa LX. Making sense(s) in dementia: a multisensory and motor-based group activity program. Am J Alzheimers Dis Other Demen 2013; 28:137-46. [PMID: 23307794 PMCID: PMC10852711 DOI: 10.1177/1533317512473194] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Lack of engagement in meaningful activities is associated with poor quality of life in dementia; thus, the development of these activities has been recommended. This pilot study aimed to develop a multisensory and motor-based group activity program for residents with dementia and assess its impact on residents' behavior. The program was designed using a multisensory and motor-based approach in sixteen 45-minute weekly sessions tailored to residents' characteristics. Four residents with advanced dementia participated in the program. The frequency and duration of the residents' behavior were assessed using video recordings. All residents participated in the proposed activities, although they were more participative and communicative in some sessions than in others. Group activity programs based on multisensory and motor stimulation can be a promising approach for people with advanced dementia; however, further research is needed. This study may serve as reference to the implementation of future programs aiming to increase person-centeredness of the care provided.
Collapse
Affiliation(s)
- Joana Cruz
- Department of Health Sciences, University of Aveiro, Aveiro, Portugal.
| | | | | | | | | |
Collapse
|
31
|
Chiu YC, Huang CY, Kolanowski AM, Huang HL, Shyu YL, Lee SH, Lin CR, Hsu WC. The effects of participation in leisure activities on neuropsychiatric symptoms of persons with cognitive impairment: a cross-sectional study. Int J Nurs Stud 2013; 50:1314-25. [PMID: 23411009 DOI: 10.1016/j.ijnurstu.2013.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/12/2013] [Accepted: 01/12/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with cognitive impairment have been shown to engage in few structured activities. During periods of unoccupied time or boredom, these patients most likely manifest neuropsychiatric symptoms. OBJECTIVE The purposes of this study were to (1) describe the leisure-activity indicators (variety in leisure activities, appraisal of each activity's restorative function, and leisure dysfunction, i.e. failure to appreciate the importance of restorative aspects of leisure activity), of community-dwelling older Taiwanese adults with cognitive impairment, and (2) explore the relationships between these indicators and neuropsychiatric symptoms in this population. DESIGN Cross-sectional. SETTING Memory disorder and geriatric psychiatric clinics of two hospitals in northern Taiwan. PARTICIPANTS Patient-family caregiver dyads (N=60). METHOD Patients' dementia severity, based on Clinical Dementia Rating scores, was 0.5-2.0. Family caregivers completed the Chinese Neuropsychiatric Inventory to assess patients' behavioral problems and the Restorative Activity Questionnaire to assess patients' participation in leisure activities, restorative experience, and leisure dysfunction. RESULTS On average, patients participated in approximately five individual leisure activities, but very few group leisure activities. The top three leisure activities were watching TV, taking a walk, and talking to relatives and friends. The leisure activities in which participants least commonly engaged were fishing, attending cultural exhibitions, and chess/card playing. All leisure-activity indicators were significantly correlated with disease stage, global cognitive function, and neuropsychiatric symptoms. Two leisure-activity indicators (leisure dysfunction and restorative experiences) were significantly correlated with depressive symptoms. Only leisure dysfunction significantly and consistently predicted neuropsychiatric symptoms. CONCLUSION These results can be used by home health or community health nurses to design tailored leisure-activity plans for improving the care quality of patients with cognitive impairment. Health professionals can develop leisure-education programmes to emphasize the value of leisure pursuit and to modify attitudes toward participating in leisure activities. Finally, parks and recreational agencies may re-examine their services and facilities to meet the increasing needs of this population.
Collapse
Affiliation(s)
- Yi-Chen Chiu
- School of Nursing and Healthy Aging Research Center, College of Medicine, Chung Gung University,Taoyuan, Taiwan, ROC.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Zimmerman S, Cohen LW, Reed D, Gwyther LP, Washington T, Cagle JG, Beeber AS, Sloane PD. Comparing families and staff in nursing homes and assisted living: implications for social work practice. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2013; 56:535-53. [PMID: 23869592 PMCID: PMC3772131 DOI: 10.1080/01634372.2013.811145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Nursing homes and residential care/assisted living settings provide care to 2.4 million individuals. Few studies compare the experience of, and relationships between, family and staff in these settings, despite ongoing family involvement and evidence that relationships are problematic. Data from 488 families and 397 staff members in 24 settings examined family involvement and family and staff burden, depressive symptoms, and perceptions; and staff absenteeism and turnover. There were few differences across setting types. Although conflict rarely occurred, there was room for improvement in family-staff relations; this area, and preparing family for their caregiving roles, are appropriate targets for social work intervention.
Collapse
Affiliation(s)
- Sheryl Zimmerman
- School of Social Work and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Menne HL, Johnson JD, Whitlatch CJ, Schwartz SM. Activity Preferences of Persons With Dementia. ACTIVITIES ADAPTATION & AGING 2012. [DOI: 10.1080/01924788.2012.696234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
34
|
Kang H. Correlates of Social Engagement in Nursing Home Residents with Dementia. Asian Nurs Res (Korean Soc Nurs Sci) 2012; 6:75-81. [DOI: 10.1016/j.anr.2012.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 05/15/2012] [Accepted: 05/15/2012] [Indexed: 11/16/2022] Open
|
35
|
Abstract
BACKGROUND Nursing home care for people with dementia is increasingly organized in small-scale care settings. This study focuses on the question of how small-scale care is related to the overall activity involvement of residents with dementia, and their involvement in different types of activities. As several studies have indicated, activity involvement is important for the quality of life of residents. METHODS Data were derived from the first measurement cycle (2008/2009) of the Living Arrangements for people with Dementia study, in which 136 care facilities and 1,327 residents participated. The relationship between two indicators of small-scale dementia care (group living home care characteristics, and the total number of residents with dementia in the facility) and activity involvement (Activity Pursuit Patterns of the Resident Assessment Instrument Minimum Data Set) were studied with multilevel multiple regression analyses. All analyses were adjusted for the residents' age, sex, neuropsychiatric symptoms, and dependency on the activities of daily living. RESULTS Residents of care facilities with more group living home care characteristics were more involved in overall and preferred activities. Furthermore, they were involved in more diverse activities. Overall, no relationship was found between the number of residents at the facility and activity involvement. CONCLUSIONS These results indicate that small-scale dementia care has a positive effect on activity involvement of residents. The current study also sheds light on the lack of activity involvement of many residents with dementia, especially those who are older, male, and with higher dependency.
Collapse
|
36
|
Möhler R, Renom A, Renom H, Meyer G. Personally-tailored activities for improving psychosocial outcomes for people with dementia in long-term care. Hippokratia 2012. [DOI: 10.1002/14651858.cd009812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ralph Möhler
- Witten/Herdecke University; School of Nursing Science, Faculty of Health; Stockumer Straße 12 Witten Germany 58453
| | - Anna Renom
- Witten/Herdecke University; School of Nursing Science, Faculty of Health; Stockumer Straße 12 Witten Germany 58453
| | - Helena Renom
- Hospital de la Santa Creu i Sant Pau; Physical Medicine and Rehabilitation (MFRHB); Carrer Sant Antoni Maria Claret, 167 Barcelona Barcelona Spain 08025
| | - Gabriele Meyer
- Witten/Herdecke University; School of Nursing Science, Faculty of Health; Stockumer Straße 12 Witten Germany 58453
| |
Collapse
|
37
|
Polenick CA, Flora SR. Increasing social activity attendance in assisted living residents using personalized prompts and positive social attention. J Appl Gerontol 2011; 32:515-39. [PMID: 25474760 DOI: 10.1177/0733464811427444] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Low levels of social activity involvement may have negative implications on overall quality of life for older adults living in residential care settings. Despite the recent growth of assisted living (AL) facilities, few studies have examined social activity participation in this environment. The present study assessed the effects of two prompt procedures that included different amounts of positive social attention (personalized prompts alone and combined with brief conversation) on the social activity attendance of 8 AL residents. Personalized prompts were designed to appeal to each participant on the basis of preference assessments regarding activity interests and preferred types of activity participation. During treatment conditions, increases in attendance occurred not only following treatment prompts but also during activities that were not preceded by treatment prompts. Similar effects were observed for both treatment prompts. Results suggest that personalized prompts and positive social attention can increase weekly social activity attendance in AL residents.
Collapse
|
38
|
Roberts E. Six for Lunch: A Dining Option for Residents with Dementia in a Special Care Unit. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/02763893.2011.621862] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
39
|
Abstract
BACKGROUND Engagement refers to the act of being occupied or involved with an external stimulus. In dementia, engagement is the antithesis of apathy. OBJECTIVE The Comprehensive Process Model of Engagement was examined, in which environmental, personal, and stimulus characteristics impact the level of engagement. METHODS : Participants were 193 residents of 7 Maryland nursing with a diagnosis of dementia. Stimulus engagement was assessed via the Observational Measure of Engagement, measuring duration, attention, and attitude to the stimulus. Twenty-five stimuli were presented, which were categorized as live human social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli. RESULTS All stimuli elicited significantly greater engagement in comparison to the control stimulus. In the multivariate model, music significantly increased engagement duration, whereas all other stimuli significantly increased duration, attention, and attitude. Significant environmental variables in the multivariate model that increased engagement were: use of the long introduction with modeling (relative to minimal introduction), any level of sound (especially moderate sound), and the presence of between 2 and 24 people in the room. Significant personal attributes included Mini-Mental State Examination scores, activities of daily living performance and clarity of speech, which were positively associated with higher engagement scores. CONCLUSIONS Results are consistent with the Comprehensive Process Model of Engagement. Personal attributes, environmental factors, and stimulus characteristics all contribute to the level and nature of engagement, with a secondary finding being that exposure to any stimulus elicits engagement in persons with dementia.
Collapse
|
40
|
O'Connor CM, Smith R, Nott MT, Lorang C, Mathews RM. Using video simulated presence to reduce resistance to care and increase participation of adults with dementia. Am J Alzheimers Dis Other Demen 2011; 26:317-25. [PMID: 21624886 PMCID: PMC10845485 DOI: 10.1177/1533317511410558] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND Cognitive and functional decline in dementia generally impairs performance of basic care activities. Staff assistance during these activities frequently results in confusion, anxiety, and distress, expressed through resistance to care (RTC). METHODS A single-system ABA withdrawal design (n = 1) evaluated the effect of video-simulated presence (VSP) for decreasing RTC and increasing participation. A family member pre-recorded videos for use during episodes of RTC, in which the family member spoke directly to the participant to encourage participation. RESULTS Introduction of the VSP significantly reduced RTC during the basic care tasks of feeding and talking medication. This effect was reversed when the intervention was withdrawn. Participation increased following VSP, demonstrating clear trends toward clinical significance. CONCLUSIONS This person-centered intervention, based on VSP of a family member, provides encouraging results for reducing RTC and increasing participation of adults with dementia in basic care tasks.
Collapse
Affiliation(s)
- C M O'Connor
- University of Sydney, New South Wales, Australia.
| | | | | | | | | |
Collapse
|
41
|
Social engagement and depressive symptoms of elderly residents with dementia: a cross-sectional study of 37 long-term care units. Int Psychogeriatr 2011; 23:625-33. [PMID: 21073769 DOI: 10.1017/s1041610210002061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Social engagement and depression are important outcomes for residents with dementia in long-term care. However, it is still largely unclear which differences in social engagement and depression exist in residents of various long-term care settings and how these differences may be explained. This study investigated the relationship between social engagement and depressive symptoms in long-term care dementia units, and studied whether differences in social engagement and depressive symptoms between units can be ascribed to the composition of the resident population or to differences in type of care setting. METHODS Thirty-seven long-term care units for residents with dementia in nursing- and residential homes in the Netherlands participated in the study. Social engagement and depressive symptoms were measured for 502 residents with the Minimum Data Set of the Resident Assessment Instrument. Results were analyzed using multilevel analysis. RESULTS Residents of psychogeriatric units in nursing homes experienced low social engagement. Depressive symptoms were most often found in residents of psychogeriatric units in residential homes. Multilevel analyses showed that social engagement and depressive symptoms correlated moderately on the level of the units. This correlation disappeared when the characteristics of residents were taken into account. CONCLUSIONS Social engagement and depressive symptoms are influenced not only by individual characteristics but also by the type of care setting in which residents live. However, in this study social engagement and depressive symptoms were not strongly related to each other, implying that separate interventions are needed to improve both outcomes.
Collapse
|
42
|
Hill NL, Kolanowski A, Kürüm E. Agreeableness and Activity Engagement in Nursing Home Residents with Dementia. J Gerontol Nurs 2010; 36:45-52. [DOI: 10.3928/00989134-20100330-10] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 12/09/2009] [Indexed: 01/10/2023]
|
43
|
Cohen-Mansfield J, Marx MS, Regier NG, Dakheel-Ali M. The impact of personal characteristics on engagement in nursing home residents with dementia. Int J Geriatr Psychiatry 2009; 24:755-63. [PMID: 19156701 PMCID: PMC3139219 DOI: 10.1002/gps.2192] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the impact of personal attributes on engagement in persons with dementia. METHODS Participants were 193 residents of seven Maryland nursing homes. All participants had a diagnosis of dementia. Cognitive functioning was assessed via the Mini-Mental State Examination, and engagement was assessed via the Observational Measure of Engagement. Data pertaining to activities of daily living were obtained from the Minimum Data Set. RESULTS Women had longer mean engagement duration than men, and significant results were not seen with the other demographic variables. Significant, positive correlations were found between higher cognitive functioning and longer engagement duration, more attention, a more positive attitude, and a higher refusal rate. There was a positive and significant correlation between the comorbidity index and engagement duration, and between the number of medications and attention. All functional status variables yielded significance in a positive direction. Participants with poor hearing had a higher refusal rate. Cognitive status was the most consistent and potent predictor of engagement in this population. CONCLUSION Despite a higher refusal rate among those with higher cognitive levels, their overall engagement with stimuli is higher. Caregivers should anticipate higher refusal rates in those with poor hearing, and therefore compensatory methods should be used in presenting stimuli in this population. The potent role of cognitive and functional status on engagement of persons with dementia underscores the importance of tailoring activities to nursing home residents' needs, interests, and limitations.
Collapse
Affiliation(s)
- Jiska Cohen-Mansfield
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD 20852, USA.
| | - Marcia S. Marx
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD, USA
| | - Natalie G. Regier
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD, USA
| | - Maha Dakheel-Ali
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD, USA
| |
Collapse
|
44
|
|
45
|
Robison J, Curry L, Gruman C, Porter M, Henderson CR, Pillemer K. Partners in caregiving in a special care environment: cooperative communication between staff and families on dementia units. THE GERONTOLOGIST 2007; 47:504-15. [PMID: 17766671 DOI: 10.1093/geront/47.4.504] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This article reports the results of a randomized, controlled evaluation of Partners in Caregiving in a Special Care Environment, an intervention designed to improve communication and cooperation between staff and families of residents in nursing home dementia programs. DESIGN AND METHODS Participants included 388 family members and 384 nursing staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Project staff conducted training sessions on communication and conflict-resolution techniques with two groups at the intervention sites: staff and residents' family members, followed by a joint meeting with facility administrators. RESULTS Families, staff, residents, and facility programs in the intervention facilities all demonstrated positive outcomes from program participation. Families experienced significant improvement in communicating with staff and in staff behaviors toward them, and spouses of residents increased their care involvement. Staff reported reduced conflict with families and reduced depression; burnout for nurses increased for individuals in the control group but not those in the treatment group. Behavioral symptoms decreased for residents, and facilities implemented more family-focused programs. IMPLICATIONS Effective staff and family partnerships are critical in caring for residents with dementia. The Partners in Caregiving in a Special Care Environment program is an evidence-based intervention that enables these partnerships to develop and thrive, translating into improved experiences for residents, families, and staff.
Collapse
Affiliation(s)
- Julie Robison
- Center on Aging, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-6147, USA.
| | | | | | | | | | | |
Collapse
|
46
|
Maas ML, Buckwalter KC. Providing Quality Care in Assisted Living Facilities: Recommendations for Enhanced Staffing and Staff Training. J Gerontol Nurs 2006; 32:14-22. [PMID: 17112134 DOI: 10.3928/00989134-20061101-04] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Meridean L Maas
- John A. Hartford Center of Geriatric Nursing Excellence, University of Iowa College of Nursing, Iowa City, Iowa 52246, USA
| | | |
Collapse
|
47
|
Dobbs D, Hayes J, Chapin R, Oslund P. The relationship between psychiatric disorders and the ability to age in place in assisted living. Am J Geriatr Psychiatry 2006; 14:613-20. [PMID: 16816015 DOI: 10.1097/01.jgp.0000209268.37426.69] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Residential care/assisted living (RC/AL) has become a popular long-term care option in the past decade, in part because these settings offer residents a more home-like environment than nursing homes (NHs) while still offering supervision and assistance to meet individuals' personal and healthcare needs. One of the goals of RC/AL is to facilitate residents' ability to age in place by providing access to needed services and thereby delaying NH admission. This article explores individual and facility-level characteristics associated with discharge from RC/AL to NH with particular attention to persons with a psychiatric disorder. METHODS A Cox proportional hazards model was used to examine the risk factors associated with discharge from RC/AL to NH for a nonrandom sample of 366 residents in 37 RC/AL facilities in one state. RESULTS Thirty-two percent of residents sampled had a psychiatric disorder. Residents with a psychiatric disorder were 1.78 times more likely to discharge to a NH. Other factors significantly associated with discharge from a RC/AL to NH included age (older), being married, more hospitalizations, for-profit ownership status, and part of a NH or continuing care retirement community. CONCLUSION This article identifies both facility and individual characteristics that increase the likelihood of RC/AL residents discharging to NHs. Given that one of the main findings is that persons with a psychiatric disorder are at increased risk of discharge to NH, there is a need for improved provision of services for this population in RC/ALs to reduce premature discharge to NHs and to support aging in place in RC/ALs.
Collapse
Affiliation(s)
- Debra Dobbs
- School of Aging Studies, University of South Florida, Tampa, Florida 33620, USA.
| | | | | | | |
Collapse
|
48
|
Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2006; 21:500-7. [PMID: 16739260 DOI: 10.1002/gps.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|