Safeness and Treatment Mitigate the Effect of Loneliness on Satisfaction With Elderly Care

The impact of spouse health on social participation of older adults in China: Evidence from the CLHLS

BACKGROUND

China is dealing with a serious aging issue. Social participation is essential for active aging. The health status of spouses is intertwined with the trajectory of the social function of the elderly.

OBJECTIVES

This study examined the association between spouse health and social participation among older Chinese adults. The study also explored the mediating role of loneliness and anxiety between spousal health and social participation.

METHODS

The analytic sample included 6125 adults aged 60 years and above. Prospective data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). First, we described basic socio-demographic information about the sample. Secondly, Spearman's correlation analysis was used to determine whether correlations existed between spousal health, loneliness, anxiety, and social participation. Finally, mediation analysis was run using the SPSS macro PROCESS program.

RESULTS

Spousal health, loneliness, anxiety, and social participation were significantly correlated (P < 0.01). Spousal health could not only have a direct positive impact on social participation in older adults (β = 0.239, 95 % CI: 0.120, 0.359), but also indirectly on social participation through three pathways: an independent mediating effect of loneliness (β = 0.020, 95 % CI: 0.009, 0.034), an independent mediating effect of anxiety (β = 0.018, 95%CI: 0.009, 0.032), and a chain mediating effect of loneliness and anxiety (β = 0.004, 95%CI: 0.002, 0.007).

CONCLUSION

This study suggests paying more attention to elderly couples and decreasing the negative consequences of changes in spousal health.

Listening to the voice of older people: dimensions of loneliness in long-term care facilities

Loneliness has proved to be common in long-term care facilities (LTCF) and is associated with adverse health outcomes. Although older residents have expressed their experiences of loneliness in previous studies in various ways, researchers have rarely distinguished or explored the three dimensions of loneliness: social, emotional and existential. Furthermore, descriptions of existential loneliness in LTCF is still a neglected area of research. The aim of this study was to explore how the experiences of loneliness of older people in LTCF are manifested and divided into these dimensions. We used an ethnographic multi-method approach. The analysis leaned on abductive reasoning. In terms of social loneliness, the respondents missed company and lacked peer support, but also felt lonely in a crowd. Emotional loneliness felt miserable and could not be shared with anyone. It was related to a feeling of meaninglessness of life and a lack of meaningful others. Existential loneliness was characterised by waiting and a feeling of emptiness. It reflected the fundamental issues of humanity. The present study is one of the first to explore the dimensions of the experiences of loneliness among frail and cognitively impaired older people in LTCF. According to the voices of the lonely respondents, loneliness has many social, emotional and existential aspects. These features of loneliness should be recognised in studies, care practices and interventions.

What defines quality of care for older people in aged care? A comprehensive literature review

The quality of the care provided to frail older people in aged care is a concern for all Australians and for the citizens of many other countries internationally. This paper summarizes the methods and findings from an Australian study commissioned by the Royal Commission into Aged Care Quality and Safety to identify and synthesize international literature relating to the quality of care in aged care. A comprehensive literature review was undertaken to search and identify the literature (grey and peer reviewed) relating to quality of care and/or person-centered care in aged care. The review identified nine key themes as salient to the quality of care experience, which include treating the older person with respect and dignity; acknowledging and supporting their spiritual, cultural, religious and sexual identity; the skills and training of the aged care staff providing care; relationships between the older person and the aged care staff; social relationships and the community; supporting the older person to make informed choices; supporting the older person's health and well-being; ensuring the delivery of safe care in a comfortable service environment; and the ability to make complaints and provide feedback to the aged care organization. In practice, particularly in the context of residential care, quality of care has traditionally been measured using clinical indicators of care quality. These findings highlight the central importance of person-centered care and care experience as fundamental tenets of the quality of aged care service delivery in Australia and internationally. Geriatr Gerontol Int 2021; 21: 765-778.

Gender difference in unmet need for assistance with activities of daily living among disabled seniors in China : a cross-sectional study

OBJECTIVES

This study explores the gender difference in unmet need for assistance with activities of daily living among older adults with disabilities in China.

DESIGN

Logistic regression analysis was employed to examine the gender difference and identify influential factors among disabled male and female seniors.

SETTING

23 provinces throughout China.

PARTICIPANTS

A total of 1700 disabled seniors were included in the analysis.

RESULTS

Of 1700 respondents, 619 (36.4%) were disabled male seniors. Overall, the possibility of unmet need for activity of daily living assistance among disabled female seniors was significantly lower than that among male group (OR 0.728; 95% CI 0.559 to 0.948) than males. Family care resources, economic status and loneliness were influential factors among disabled seniors regardless of genders. Furthermore, disabled female seniors from rural area (p=0.011), whose primary caregiver was willing to take care of them (p=0.022), whose community could provide daily life service (p=0.002) were more likely to have unmet need. Meanwhile, disabled female seniors whose community could provide medical service(p=0.001) were less likely to report unmet need.

CONCLUSIONS

The study showed that disabled male seniors were more likely to experience unmet need compared with female ones. Reducing unmet need for assistance with activities of daily living among disabled seniors and existing gender disparities therefore requires not only universal strategy, but also targeted policies which should be made or modified for disabled seniors of different genders.

Linking supportive leadership to satisfaction with care: proposing and testing a service-profit chain inspired model in the context of elderly care

PURPOSE

As marketization has gained ground in elderly care, satisfaction with care has come to play a crucial role in designing for high-quality care. Inspired by the service-profit chain (SPC) model, the authors aimed to gain a deeper understanding of the intricate interplay between supportive leadership practices, organizational climate, job satisfaction and service quality by predicting satisfaction with care.

DESIGN/METHODOLOGY/APPROACH

A Swedish sample of frontline elderly care staff (n = 1,342) participated in a cross-sectional questionnaire study. Mediation analyses were conducted to test the proposed model.

FINDINGS

As predicted, engaging in supportive leadership practices was directly and positively associated with satisfaction with care. In addition, as predicted, this relationship was partially mediated by organizational climate and job satisfaction. Moreover, job satisfaction predicted satisfaction with care with service quality explaining a statistically significant part of this relationship.

PRACTICAL IMPLICATIONS

Managers in elderly care services may improve satisfaction with care in multiple ways but primarily by showing that they care about the staff and ensuring that they are satisfied with their working conditions. Employee job satisfaction seems to be particularly crucial for satisfaction with care, beyond what can be accounted for by care service quality.

ORIGINALITY/VALUE

The authors proposed a novel service-outcome model. Adding to the original SPC model, the model in this study suggested and validated previously unexplored relationships including a direct path between leadership practices and satisfaction with service and a multiple-mediator model explaining this relationship. Also, new measures of organizational climate and supportive leadership were developed for which satisfactory reliability estimates were obtained.

User and family satisfaction with nursing homes: a systematic review

BACKGROUND

Implementation of person-directed care planning is a challenge for nursing home services. User satisfaction is indispensable to implement it.

OBJECTIVE

The aim of this study was to address user and family satisfaction with nursing homes and the scales used and to identify the determinants of satisfaction with this service.

METHODS

A systematic review was conducted, and the Cochrane Library, PubMed, Scopus, Web of Science and CINAHL databases were searched between December 2019 and April 2020. Studies involving assessment of user or family satisfaction with nursing homes and users ≥65 years old or their families were included in this review. The methodological quality of the included studies was assessed by the Joanna Briggs Institute reviewer's manual.

RESULTS

Eight articles were included based on the eligibility criteria, from a total of 2378 records found in the electronic search. All studies presented a cross-sectional design, and the total sample of this review was 57 214 older people. Most of the studies included showed positive overall satisfaction with nursing homes. There was no consensus about the best scale to assess satisfaction because of the huge variety of tools among studies. The most common determinants of satisfaction among studies were quality of life (mental and physical components), anxiety and social and health factors.

CONCLUSION

The findings of our review may contribute to a better view of satisfaction with nursing homes experienced by users and families and to an improvement of care in these institutions.

Understanding client satisfaction in elderly care: new insights from social resource theory

Social resource theory suggests that social interaction can be conceived as resource transaction or exchange with behaviours falling within six fundamental resource categories (i.e. love, status, information, money, goods, and services) organised along two underlying dimensions: particularism-universalism and concreteness-abstractness. With the purpose of extending knowledge about quality of care, this study adopts a novel approach in that it describes and categorises care behaviours using social resource theory instead of using single instances of care behaviour. The categorisation is further used to predict client satisfaction in care services targeting older people. Daily interactions between care staff and older persons were observed in two different residential care facilities using a structured non-participant observation design. The data were analysed using principal component analysis, correlation, and regression analysis. The results confirmed the hypothesis that satisfaction with care services is predicted by resource transactions that are high on the underlying dimensions of particularism and abstractness. Thus, the resource categories of love and status (resource categories high on particularism and abstractness) were shown to be strong predictors of client satisfaction. The use of social resource theory is a novel and appropriate approach to examine person-centred care and satisfaction with care. Also, in addition to addressing potential problems in previous self-report studies on care staff behaviour, the observational technique was highly practical to this service area where dealing with clients not always able to provide feedback directly.

Changes in prevalence of loneliness over time in institutional settings, and associated factors

OBJECTIVES

The aim of this study was to examine changes in the prevalence of loneliness over time from 2011 to 2017 in long-term care facilities; and its related factors.

MATERIAL AND METHODS

Repeated cross-sectional studies exploring loneliness and its associated factors among residents in long-term care facilities were conducted in Helsinki, Finland in 2011 (N = 4966) and 2017 (N = 3767). Residents in temporary respite care or with severe cognitive impairment, and those unable or refusing to respond to the loneliness item were excluded. The total number of participants in this analysis was 1563 in 2011, and 1367 in 2017. In both samples, we used the same loneliness measurement by asking "Do you suffer from loneliness?" (never/sometimes/often or always). When comparing the samples in order to reduce the effect of confounding between them, we used propensity score matching. A multivariable logistic regression model explored the relationship between various characteristics and loneliness.

RESULTS

Loneliness showed no change in prevalence over time: propensity score-adjusted loneliness was 36 % in 2011 and 2017. In the multivariate logistic regression model, feeling depressed was the only independent characteristic associated with loneliness. Of the respondents who did not feel depressed, 24 % suffered from loneliness at least sometimes. Among the respondents who felt depressed, the respective figure was 55 %.

CONCLUSION

Loneliness is common in institutional settings. It remained stable, and not decreased over time. Because loneliness impairs the well-being, quality of life and health of residents, it needs to be addressed. Screening loneliness and developing interventions to alleviate it, is essential.

A Qualitative Study Exploring Patient Concerns and Values in Chronic Limb-Threatening Ischemia

BACKGROUND

Chronic limb-threatening ischemia (CLTI) is the debilitating end stage of peripheral artery disease, causing patients to experience low quality of life and poor health outcomes. It is unknown which aspects of care patients with CLTI value. This pilot qualitative study aims to explore patients' concerns and values related to CLTI treatment, to better inform patient-centered care.

METHODS

A qualitative study design was piloted to explore the experiences of patients with CLTI undergoing elective vascular surgery. In-depth, semistructured interviews were recorded preoperatively and 3 mo after discharge. Transcribed interviews were analyzed using content analysis, to derive patient-centered themes. Findings were mapped to a framework of patient-centered care.

RESULTS

Twelve interviews from six participants were analyzed. Five themes related to participant experiences of CLTI were identified: treatment and diagnosis, concerns about symptoms, limitations in physical function, social function, and emotional function. Participants expressed how CLTI intruded on all aspects of their lives. Framework analysis demonstrated CLTI patients valued patient-centered care relating to both relational and functional aspects of care. In particular, participants valued supportive and trustworthy care, in addition to integrated, holistic care that recognized the patient in the context of their overall health and life.

CONCLUSIONS

Feasibility was demonstrated for both study design and methodology. Data obtained from interviews were sufficiently "rich and thick" in quality and quantity to allow for common themes related to experience and health care values in patients with CLTI to be identified. If confirmed in future studies, these findings will enhance patient-centered care in CLTI.

From home care to care home: a phenomenological case study approach to examining the transition of older people to long-term care in Spain

Background and Aims

It has been the tradition in Spain until recently for families to take care of their own older relatives, but this is now changing, especially in urban areas where caring roles are also shifting. This study aims to examine the Spanish care transitions of older people moving from being traditionally a family-centred and gender-based cultural phenomenon to one that is moving gradually into professional care settings.

Method

A phenomenological case study approach was adopted, involving 15 cases exemplifying the care experience in typical primary care settings in one region of Spain, and examined how the transition from home care is happening. In-depth interviews with older people and carers with lived experience regarding the phenomenon took place.

Results

Seven themes were identified portraying the current picture of the phenomenon, evidencing that care of older people is still culturally assumed as family-centred care and a gender-based responsibility, care homes have a negative social image, there are differences between rural and urban areas, there is a lack of training for professional and family carers, and family income and dependency level accelerate the transition.

Conclusions

This study revealed a lack of care services for older people in Spain, inconsistencies in service provision, as well as a lack of professional and non-professional training.

Quality indicators for community care for older people: A systematic review

Background

Health care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality.

Methods

Relevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality.

Results

Searches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain ‘Additional evidence, formulation and usage’ (51%), followed by ‘Scientific evidence’ (39%) and ‘Stakeholder involvement’ (28%).

Conclusion

A substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes.

PROSPERO Registration: 2014:CRD42014007199

Variations in user-oriented elderly care: a multilevel approach

Purpose

National Board of Health and Welfare claims that the quality of elderly care services differ considerably between municipalities in Sweden. This study aims to analyze to what extent these variations can be accounted for by the older person’s municipality affiliation (i.e. receiving elderly care in a certain municipality).

Design/methodology/approach

Addressing this issue, national survey data from 78,538 older respondents receiving elderly care services in Sweden were analyzed using multilevel modeling (MLM).

Findings

The results showed that municipality affiliation only marginally explained the variance in satisfaction with care, i.e. its variations were larger within than between municipalities. Instead, user-oriented care accounted for the variation in satisfaction with care. Specifically, the way the care workers behave toward the older person proved to be much more crucial for satisfaction with care than municipality affiliation. Moreover, random effects analyses revealed that the effects of user-oriented care on satisfaction with care varied across municipalities. Care setting (i.e. home care or nursing home) only marginally accounted for its variance.

Practical implications

Developing care quality should start and primarily be discussed at the interpersonal care level, and not, as is customary, at the municipality level.

Originality/value

The present research is the first in its kind to quantitatively investigate the sources of variation in perceived quality of Swedish elderly care using MLM.

Cost and Satisfaction Trends in Swedish Elderly Home Care

There is a widespread belief among the public and policy makers that quality of care in terms of user satisfaction can be improved with increased spending. However, recent research indicates that structural resources (e.g., budget per elderly) in elderly home care do not predict quality of care in terms of older persons’ satisfaction with care. In the present study, we analyzed the longitudinal trends in costs and perceived quality of care across 3 years using nationwide data in Swedish elderly home care. The results showed that although costs have been steadily increasing, perceived quality of interpersonal treatment in care has remained at the same level. An important implication is that future research and policy efforts to improve quality should more directly target the mechanisms generating satisfaction.

Advancing the Big Five of user-oriented care and accounting for its variations

Purpose

– Care process quality (i.e. how care is enacted by a care worker toward a client at the interpersonal level) is a strong predictor of satisfaction in a wide range of health care services. The purpose of this paper is to describe the basic elements of care process quality as user-oriented care. Specifically, the questions of how and why quality in user-oriented care varies were investigated in the context of elderly care.

Design/methodology/approach

– Two municipalities were selected for in-depth field studies. First, in each municipality, the authors interviewed and observed care workers’ interactions with the older persons in both home care and nursing homes during two weeks (Study 1). Second, in an attempt to gain a deeper understanding of why process quality in terms of user-oriented care varies, the authors conducted interviews with care workers and care unit managers (Study 2).

Findings

– A new taxonomy for categorizing process quality variation, the Big Five of user-oriented care (task-focus, person-focus, affect, cooperation, and time-use), is proposed. In addition, the perceived reasons for process quality variation are reported in our own developed Quality Agents Model, suggesting that variations in care process evaluations may be explained from different perspectives at multiple levels (i.e., older person, care worker-, unit-, department-, and municipality level).

Originality/value

– The proposed taxonomy and model are useful for describing user-oriented care quality and the reasons for its variations. These findings are of relevance for future quality developments of elderly care services, but also may be adapted to applications in any other enterprise employing a user-oriented approach.