The preliminary effects of laughter therapy on loneliness and death anxiety among older adults living in nursing homes: A nonrandomised pilot study

Effects of humor therapy on negative emotions, quality of life and cognitive function in older adults: A systematic review and meta-analysis

OBJECTIVE

To systematically review the intervention effects of humor therapy on older adults.

METHODS

We searched Chinese and English databases for studies on humor therapy interventions for older adults and performed meta-analysis using stata 15 software.

RESULTS

A total of 9 randomized controlled trials and 4 quasi-experimental studies, with a pooled sample of 984 participants, met our inclusion criteria. Meta-analysis showed that humor therapy significantly improved depression (SMD = -0.66, 95 %CI:-0.95 to -0.36, p < 0.001), loneliness (SMD = -1.52, 95 % CI:2.66 to -0.39, p = 0.008), quality of life (SMD = 0.42, 95 %CI: 0.23 to 0.62, p < 0.001) in older adults. Qualitative analysis revealed significant effects of humor therapy on happiness, stress, and brief resilience, but non-significant effects on cognitive functioning in older adults.

CONCLUSIONS

Humor therapy can reduce depression and loneliness and improve quality of life in older adults, but current evidence does not support humor therapy as an effective intervention to improve cognitive functioning in older adults. Need for further studies to confirm these findings and investigate potential mechanisms.

Social connection in long-term care homes: a qualitative study of barriers and facilitators

BACKGROUND

Social connection is a basic human need and is essential to quality of life. It is associated with better mental and physical health outcomes for long-term care (LTC) home residents and is a key aspect of quality of care and person-centred care. There are considerations for LTC homes that may present obstacles to and opportunities for social connection. It is therefore important to understand what restricts or enables good social connection in LTC homes, to guide better quality care and future interventions in this population. This qualitative study aims to identify barriers and facilitators to social connection for LTC residents.

METHODS

We used thematic analysis to describe themes derived from individual and group qualitative interviews from 67 participants (18 residents, 17 staff members and clinicians, 32 family members and friends) recruited from LTC homes in the United Kingdom and Canada.

RESULTS

Themes were grouped into four categories: (1) becoming familiar with life in the LTC home to support social connection; (2) physical and virtual access beyond the LTC home as strategies to maintain contact; (3) getting to know residents to deepen relationships; (4) person-centred approaches to build social connection. 'Becoming familiar with life in the LTC home to support social connection' described the benefits of counteracting the institutionalized feel of LTC homes, enabling LTC residents to spend time in meaningful ways, and increasing freedom of mobility around the home. 'Physical and virtual access beyond the LTC home as strategies to maintain contact' related to the benefits of outings, providing support with technology, and involving family and friends in LTC home life. 'Getting to know residents to deepen relationships' related to the benefits of using routine care and interactions as opportunities for social contact, using family and friend knowledge as a resource, and fostering resident relationships. 'Person-centred approaches to build social connection' included considering physical, mental, cognitive, and sensory impairments, accounting for adjustment and sociability, using communal spaces well, and prioritizing psychosocial needs.

CONCLUSIONS

This study identifies barriers and facilitators to social connection for LTC residents which can be addressed in care policies, staff selection and training, and can inform policies and interventions to build and maintain social connection in LTC homes.

CLINICAL TRIAL NUMBER

clinicaltrials.gov ID NCT05315960.

The Effect of Laughter Yoga Applied to Intensive Care Nurses on Their Perceived Stress, Job Motivation, and Mental Well-being: Randomized Controlled Study

AIM

The aim of this study was to examine the effect of laughter yoga applied to intensive care nurses on perceived stress, job motivation, and mental well-being.

DESIGN

This study was a randomized controlled trial.

METHODS

The study was conducted with nurses working at the university hospital's surgical intensive care and anesthesia intensive care units of the third-level intensive care unit in Turkey. Data obtained from 30 participants in the intervention group and 33 participants in the control group were analyzed. The Nurse Introduction Form, Nurse Job Motivation Scale, Perceived Stress Scale, and Warwick-Edinburgh Mental Well-being Scale were used to collect data. Data obtained from the study were evaluated using the SPSS 22.0 package.

RESULTS

It was determined that there was no statistically significant difference in the average scores of the pretest/posttest 1/posttest 2 of the Perceived Stress Scale (13.70 ± 3.33 to 14.57 ± 4.57, P > .05; 13.50 ± 3.15 to 13.48 ± 4.59, P > .05; and 13.56 ± 3.15 to 13.15 ± 3.49, P > .05, respectively) and Work Motivation Scale (59.70 ± 7.58 to 59.69 ± 7.98, P > .05; 60.30 ± 8.07 to 58.48 ± 8.94, P > .05; and 60.56 ± 7.86 to 57.93 ± 9.54, P > .05, respectively) for both the intervention and control groups of nurses. A statistically significant difference was found in the average scores of the Warwick-Edinburgh Mental Well-Being Scale pretest/posttest 1/posttest 2 for the intervention group of nurses (50.90 ± 7.60, 51.50 ± 7.80, and 53.70 ± 7.08, respectively; F = 3.330, P = .043). However, the difference was found to be insignificant in pairwise comparisons in the further analysis (a = b = c). It was determined that there was no statistically significant difference in the average scores of the Warwick-Edinburgh Mental Well-Being Scale pretest/posttest 1/posttest 2 for the control group of nurses (52.21 ± 9.89, 51.93 ± 10.45, and 51.03 ± 9.63, respectively; P > .05).

CONCLUSIONS

The application of laughter yoga on intensive care nurses did not result in a significant change in perceived stress levels and work motivation. However, statistically significant differences were observed in the average mental well-being scores among the intervention group.

Death anxiety among caregivers of patients with advanced cancer: a cross-sectional survey

PURPOSE

This study aimed to investigate death anxiety (DA) in caregivers of patients with advanced cancer and identify associated factors in the context of Chinese culture.

METHODS

Caregivers (N = 588) of advanced cancer patients in a tertiary cancer hospital completed anonymous questionnaire surveys. Measures included the Chinese version of the Templer Death Anxiety Scale (C-T-DAS), the Quality-of-Life Scale, the State-Trait Anxiety Scale, and the Social Support Rating Scale. Data were analyzed in SPSS (IBM Corp, Armonk, NY, USA) using descriptive statistics, Pearson's correlation test, and linear regression.

RESULTS

Respondents returned 588 (93.03%) of the 632 questionnaires. The total C-T-DAS score was 7.92 ± 2.68 points. The top-scoring dimension was "Stress and pain" (3.19 ± 1.29 points), followed by "Emotion" (2.28 ± 1.31 points) and "Cognition" (1.40 ± 0.94 points). In contrast, the lowest-scoring dimension was "Time" (1.06 ± 0.77 points). Factors associated with DA (R2 = 0.274, F = 13.348, p < 0.001) included quality of life (QoL), trait anxious personality, social support, caregiver length of care, caregiver gender, and patients' level of activities of daily living (ADL).

CONCLUSIONS

Our results demonstrated high levels of DA in caregivers of patients with advanced cancer. Generally, female caregivers and those with low social support had high DA. Caregivers caring for patients with low ADL levels or with a low QoL and trait anxious personality reported high DA. Certain associated factors help to reduce caregivers DA. Social interventions are recommended to improve the end-of-life transition and trait anxious personality as well as quality of life for caregivers.

Effects of Laughter Yoga on Patients Receiving Hemodialysis: A Systematic Review

When it comes to end-stage renal disease patients, hemodialysing is one of the most critical treatments they can receive. Even if they received hemodialysis (HD) treatment regularly, patients would experience many complications such as cardiovascular disease, fatigue, anxiety, depression, sleep disturbances, and a declining quality of life. Laughter Yoga has been reported to have many positive effects on patients with chronic illnesses. By removing or reducing stress, Laughter Yoga (LY) helps to improve patients' quality of life, Thus, they have a longer chance of survival. However, the effect of Laughter Yoga on HD patients is generally inconclusive. Objective is to evaluate LY's impact on HD patients. We searched electronic databases that included Web of Science, Embase, PubMed, the Cochrane Library, Wanfang, China National Knowledge Infrastructure, and clinical trial registries. The search period was from their inception to January 29, 2023. The search keywords included laughter therapy, laughter yoga, laugh, hemodialysis, dialysis, and renal dialysis. The systematic review included both randomized controlled trials (RCTs) and quasi-experiments studies. Three RCTs and three non-RCTs met the inclusion criteria. Laughter Yoga showed patients having improvement in several outcomes such as life quality, pain severity, sleep quality, subjective well-being, mood, depression, blood pressure, and vital capacity. A well-designed RCT will be developed to further test the potential benefits of LY for HD patients.

Quality of life and death anxiety among caregivers of patients with advanced cancer: the mediating effect of trait anxious personality and the moderating effect of social support

PURPOSE

To explore the mediating role of trait anxious personality in the association between quality of life (QoL) and death anxiety (DA), as well as to test the moderating effect of social support in the mediation model.

METHODS

The Death Anxiety Scale, Quality of Life Scale, State-Trait Anxiety Scale, and Social Support Rating Scale were used to measure 588 family caregivers of advanced cancer patients. We then constructed a moderated mediation model.

RESULTS

The presence of QoL was negatively associated with DA (β =  - 0.67, p < 0.01). Trait anxious personality partially mediated the relationship between QoL and DA (indirect effect β =  - 0.08, p < 0.01). Social support moderated both the antecedent and subsequent segments of the mediating paths of "QoL → trait anxious personality → DA" and the direct relationship between QoL and DA. Among caregivers with a low level of social support, the mediating effect coefficient of trait anxious personality was higher at 0.25 (95% confidence interval (CI): 0.059-0.182), in contrast to caregivers with a high level of social support, where the mediating effect coefficient of trait anxious personality was 0.11 (95% CI: 0.029-0.072).

CONCLUSION

QoL is directly associated with an increased risk of DA and indirectly related to DA by increasing the risk of trait anxious personality among caregivers. Social support can moderate the mediating effect of trait anxious personality and the relationship between QoL and DA. The intervention strategy for preventing DA among caregivers who have encountered QoL reduction should focus on reducing trait anxious personality and social support.

The relationship between fear of old age, loneliness and death anxiety in adults

BACKGROUND

The increase in the number of elderly people in the world, individuals' perspectives on older adults, and false beliefs and ideas about old age negatively affect adults in terms of ageing. This study was conducted to determine the relationship between fear of old age, loneliness and death anxiety in adults.

METHOD

This study, which was designed in a correlational cross-sectional descriptive model, was conducted with 1074 adult individuals living in one province in eastern Turkey. Data were collected using Personal Information Form, Fear of Old Age Scale, UCLA Loneliness Scale and Turkish Death Anxiety Scale. Data were analyzed using SPSS 25.0, AMOS 24.0, G*Power 3.1 statistical package programs.

RESULTS

In our study, it was determined that the model created in line with the hypotheses was compatible and the model fit indices were within the desired limits as χ2/df = 4.737, root mean square error of approximation = 0.05, comparative fit index = 0.93, goodness-of-fit index = 0.92, adjusted goodness-of-fit index = 0.90, IFI = 0.93. There is a significant relationship between loneliness and death anxiety (P < 0.05). There is a significant relationship between loneliness and fear of old age (P < 0.05). There is a significant relationship between death anxiety and fear of old age (P < 0.05). It was determined that death anxiety has a mediating role in the effect of loneliness on fear of old age (95% confidence interval: 0.112-0.226; P < 0.05).

CONCLUSION

As the level of loneliness increases, the level of death anxiety and fear of old age increases. Fear of old age also increases in the mediating role of death anxiety. It is recommended to conduct intervention studies to reduce fear of old age. Longitudinal study on fear of old age is recommended.

Death Anxiety and Related Factors Among Iranian Critical Care Nurses: A Multicenter Cross-Sectional Study

The aim of this study is to investigate death anxiety (DA) and related factors among critical care nurses. Using a cross-sectional research design, 325 critical care nurses in eight hospitals in Iran enrolled in the study. Multiple logistic regression analysis showed that deputy head nurse (OR = 18.299; CI: 1.764-189.817; p = .015), shift morning fixed (OR = 8.061; CI: 1.503-43.243; p = .015), surviving parents (OR = 3.281; CI: 1.072-10.037; p = .037), number of children (OR = 1.866; CI: 1.157-3.010; p = .011), years of working experience (OR = 1.143; CI: 1.048-1.246; p = .003), number of end-of-life patient care in the last 3 months (OR = .900; CI: .828-0.977; p = .012), age (OR = .809; CI: .732-.893; p < .001), CCU nurses (OR = .250; CI: .100-.628; p = .003), and mild stressful life events (SLEs) (OR = .167; CI: .046-.611; p = .007) were significantly related to high DA. Therefore, nurse managers and policymakers should pay special attention to these related factors in developing programs to maintain and promote the health of critical care nurses to improve the quality of nursing care.

Development and evaluation of the information and communication technology-based Loneliness Alleviation Program for community-dwelling older adults: A pilot study and randomized controlled trial

This study aimed to develop an information and communication technology (ICT)-based Loneliness Alleviation Program (LAP) for community-dwelling older adults, which was developed according to the ADDIE model. The LAP is a complex non-face-to-face program for physical, psychological, and interpersonal loneliness alleviation. We conducted a randomized controlled trial to verify the effects of the program on loneliness, depression, and laughter index in older adults. Program sessions were conducted twice a week for 6 weeks (12 sessions). Data on 40 older adults aged 65 years and above were collected from January 2, 2023 to February 17, 2023 at a public health center in South Korea. The experimental group showed statistically significant effects of the program on loneliness, depression, and laughter index scores. The older adults were alleviated their loneliness by utilizing non-face-to-face programs, and the program is expected to increase continuity and inclusiveness of care.

Intervention and application of clown care in nursing homes: a scoping review

BACKGROUND

The purpose of this scoping review was to organize and describe the literature on the application of clown care to the elderly population in nursing homes, including intervention time, intervention methods and intervention effects, so as to provide reference ideas for other scholars to explore clown care programs suitable for the elderly population in nursing homes.

METHODS

Employing Arksey and O'Malley's methodology, we searched for PubMed, Web of Science, Embase, Cochrane, CNKI, WanFang, VIP, and CBM systematically and thoroughly, and the search period was from the establishment of each database to December 12, 2022. Two researchers with evidence-based learning experience independently conducted literature retrieval, information extraction, and cross-checking in strict accordance with the inclusion and exclusion criteria. The review process is reported according to PRISMA.

RESULTS

148 literature were initially obtained after searching, of which 18 were finally included. Among them, 17 were in English and 1 was in Chinese. There are 16 quantitative studies and 2 qualitative studies published from 2010 to 2022. It is found that the current clown care intervention program has not established a unified intervention standard and effective evaluation program.

CONCLUSIONS

The results of this scoping review conclude that clown care played a significant role in the nursing home. At first, it can reduce negative emotions, cognitive impairments and physical pain among older adults. In addition, it can improve their quality of life, life satisfaction, etc. It is suggested to learn from the advanced experience of clown care in foreign countries and carry out more clown care among the elderly population in nursing homes in China.

The effect of laughter yoga on loneliness, psychological resilience, and quality of life in older adults: A pilot randomized controlled trial

This study aims to examine how laughter yoga affects the loneliness, psychological resilience, and quality of life of older adults living in a nursing home. The sample of this intervention study, made using a control group with a pretest/posttest design, consists of 65 older adults living in Turkey. The data were collected in September 2022 using the Personal Information Form, the Loneliness Scale for the Elderly, the Brief Psychological Resilience Scale, and the Quality of Life Scale for the Elderly. The intervention group (n=32) took part in laughter yoga twice a week for four weeks. No intervention was made with the control group (n=33). A statistically significant difference was found between the groups' mean post-test scores for loneliness, psychological resilience, and quality of life (p < 0.05) after the laughter yoga sessions. The eight-session laughter yoga program was found to reduce loneliness and increase resilience and quality of life in older adults.

Association between loneliness and its components and cognitive function among older Chinese adults living in nursing homes: A mediation of depressive symptoms, anxiety symptoms, and sleep disturbances

OBJECTIVE

This study aimed to investigate the associations between loneliness and its components and cognitive function among older Chinese adults living in nursing homes and to test whether depressive symptoms, anxiety symptoms, and sleep disturbances mediate these associations.

METHODS

The sample comprised 228 Chinese individuals aged ≥ 65 years living in nursing homes who were free of dementia and psychiatric or serious somatic diseases. Loneliness was evaluated using the UCLA Loneliness Scale. Global cognitive function was assessed using the Beijing version of the Montreal Cognitive Assessment. Multivariable linear regression analyses were performed to examine the associations between loneliness and its components and global cognitive function. A mediation analysis was used to test the potential mediating effects of depressive symptoms, anxiety symptoms, and sleep disturbances.

RESULTS

The mean (SD) age of the participants was 80.8 (6.3) years, and 58.3% were women. Compared with the lowest quartile of loneliness degree, the multivariable-adjusted beta coefficient (95% confidence interval [95% CI]) for the highest quartile was -1.32 (-2.61 to -0.02) (P for trend = 0.03). Loneliness components, personal feelings of isolation and the lack of relational connectedness but not the lack of collective connectedness, were also inversely associated with cognitive function. Significant indirect effects on cognitive function were observed for loneliness and its two components (personal feelings of isolation and the lack of relational connectedness) in mediating pathways via depressive symptoms, anxiety symptoms, and sleep disturbances (all p < 0.05).

CONCLUSIONS

A higher degree of loneliness and its two components, personal feelings of isolation and the lack of relational connectedness, are associated with worse cognitive function among Chinese residents in nursing homes. Depressive symptoms, anxiety symptoms, and sleep disturbances may at least partially mediate these associations.

The effect of laughter therapy on nursing students' anxiety, satisfaction with life, and psychological well-being during the COVID-19 pandemic: Randomized controlled study

Background

Changes in routine due to the pandemic have increased nursing students' anxiety about clinical learning. The inadequacy experienced before graduation caused them to experience high levels of anxiety characterized by feelings of insecurity and unhappiness and negatively affected their life satisfaction. Methodological studies are needed to confirm the efficacy of laughter therapy, which is effective in reducing anxiety and stress, on the online platform. The current study protocol was designed to evaluate the effect of online laughter therapy on anxiety, life satisfaction, and psychological well-being.

Methods

Forty students were selected for the intervention group and forty students for the control group by assigning 1:1 with a real random number selector among 140 senior nursing students who made up the universe. The intervention group received ten sessions of online laughter therapy two days a week for five weeks. Participants in the control group did not receive any intervention during the study. Data were obtained at the beginning of the study and after five weeks with the 'State-Trait Anxiety Inventory', 'Satisfaction with Life Scale' and 'Psychological Well-Being Scale'.

Results

After laughter therapy, the intervention result showed a significant increase in life satisfaction and psychological well-being scores (p < 0.001) and a significant decrease in anxiety scores (p < 0.001) in the intervention group compared to the control group.

Conclusion

The study reveals that online laughter therapy significantly positively affects nursing students' anxiety, life satisfaction, and psychological well-being.

Coping Using Sex, Health-Related Behaviors, and Mental Health During COVID-19 Lockdown in the UK

BACKGROUND

Peoples' sexual behaviors have changed during the period of enforced COVID-19 social distancing, in some cases, to cope with negative feelings during lockdown. Research on coping using sex is relatively restricted to samples of men with a history of sexual offending, and it is unknown whether coping using sex is associated with health-related behaviors and mental health in the general population.

AIM

We examined if coping using sex before and during lockdown was associated with adverse outcomes (i.e., self-perceived reduction in health-related behaviors and mental health) in a community sample.

HYPOTHESES

We hypothesized that participants who reported greater use of sex to cope in the weeks preceding lockdown would show a greater decline in health-related behaviors and mental health during lockdown. Furthermore, that changes in coping using sex resulting from lockdown would account for further variance in the worsening of health-related behaviors and mental health.

METHODS

Participants were UK residents, aged 18-60 years, and fluent in English. 789 participants completed an online survey, providing demographic information, self-reported social distancing, loneliness, and coping using sex over a 14-day period during lockdown, and retrospectively preceding lockdown.

OUTCOMES

Participants reported perceived changes in health-related behaviors and mental health symptomatology during lockdown compared to before the pandemic. They also self-reported levels of stress, anxiety and depression during lockdown.

RESULTS

Greater coping using sex prior to lockdown predicted positive change in health-related behaviors, for example, higher scores were associated with participants reporting having exercised and slept more. It was also associated with higher trait levels of anxiety, stress and depression during lockdown. Changes in coping using sex from before to during lockdown did not predict perceived changes in health related behaviors or mental health symptomatology.

CONCLUSIONS

Overall, greater coping using sex prior to lockdown was associated with worse mental health symptomatology during lockdown (anxiety, depression and stress), however, it was also associated with perceived positive change in health-related behaviors compared with before lockdown. This suggests that coping using sex may be associated with negative emotional reactions during lockdown, but may also be linked with positive change in health-promoting behaviors.

Effects of laughter therapy on the stress response of married immigrant women in South Korea: A randomized controlled trial

The authors aimed to investigate the effects of a laughter therapy (LT) program on the acculturative stress, anxiety, depression, salivary cortisol, and salivary IgA of married immigrant women in South Korea. A randomized waiting-list control design was utilized. The 19 experimental group participants were given LT twice a week for 2 weeks, whereas the 22 participants in the waiting-list control group received no treatment during the same period but received it afterward. Outcomes were measured right after the completion of the intervention and 2 weeks later. The experimental group showed significantly decreased levels of acculturative stress, anxiety, depression, and salivary cortisol compared to the control group. As for salivary IgA, however, the experimental group showed no statistically significant decrease compared to the control group. An LT program can be a good option for married immigrant women undergoing acculturation experiences in consideration of its effectiveness.

[Loneliness in nursing homes-Experience and measures for amelioration : A literature review]

BACKGROUND

Public health and health economics consider loneliness to be an important determinant of health and quality of life for all people. For older people, loneliness can be considered as possibly the most important health determinant.

OBJECTIVE

The purpose of this paper is to describe the experience of loneliness from the perspective of residents in residential long-term care and to identify interventions to reduce loneliness by caregivers.

MATERIAL AND METHODS

Systematic literature search and study evaluation.

RESULTS

Talking about their loneliness is not easy for many residents. The manifestations of loneliness vary from being alone, to boredom and to not feeling at home. Interventions range from the use of laughter yoga and animal-assisted therapy to technological measures and the use of volunteers.

CONCLUSION

Measures that focus on the spiritual level of relationship building and trust have proven to be most effective.

Effects of laughter yoga on hemodialysis patients' plasma-beta endorphin levels, pain levels and sleep quality: A randomized controlled trial

This study evaluates the effects of "laughter yoga" on the plasma beta-endorphin levels, pain levels and sleep quality of hemodialysis patients. It is a randomized controlled trial. The study was carried out between July and October 2018. A total of 68 patients receiving hemodialysis treatment at two different dialysis centers were included in the study. The duration of the laughter yoga was 30 min, and a total of 16 sessions were performed on a twice-weekly basis. The data were collected by using a socio-demographic information form, the Visual Analog Scale and the Pittsburgh Sleep Quality Index, and blood samples were collected to determine beta-endorphin levels. Following the laughter yoga implementation, the pain level of the intervention group patients significantly decreased, and their sleep quality significantly improved. No significant change occurred in the patients' beta-endorphin levels. Laughter yoga was effective in reducing pain and increasing sleep quality.

Effects of Laughter Therapy on Life Satisfaction and Loneliness in Older Adults Living in Nursing Homes in Turkey: A Parallel Group Randomized Controlled Trial

PURPOSE

This study examined the effects of laughter therapy on life satisfaction and loneliness in older adults living in nursing homes.

DESIGN

A single-blind, parallel-group, randomized controlled trial (ClinicalTrials NCT03687788) with a pretest-posttest design was conducted.

METHODS

There were 31 experimental participants and 31 controls. The experimental group received laughter therapy twice a week for 6 weeks, along with usual care. The control group received usual care only. Loneliness was measured with the De Jong Gierveld Loneliness Scale, and life satisfaction was measured with the Satisfaction With Life Scale.

FINDINGS

After 6 weeks, there was a statistically significant difference in De Jong Gierveld Loneliness Scale total score between the two groups, and the subscale scores of the experimental group decreased.

CONCLUSIONS

Laughter therapy may reduce loneliness in older adults.

CLINICAL RELEVANCE

Healthcare professionals, especially nurses, can potentially use laughter therapy to reduce loneliness in older adults.

Interventions to reduce social isolation and loneliness during COVID-19 physical distancing measures: A rapid systematic review

BACKGROUND

A significant proportion of the worldwide population is at risk of social isolation and loneliness as a result of the COVID-19 pandemic. We aimed to identify effective interventions to reduce social isolation and loneliness that are compatible with COVID-19 shielding and social distancing measures.

METHODS AND FINDINGS

In this rapid systematic review, we searched six electronic databases (Medline, Embase, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews and SCOPUS) from inception to April 2020 for systematic reviews appraising interventions for loneliness and/or social isolation. Primary studies from those reviews were eligible if they included: 1) participants in a non-hospital setting; 2) interventions to reduce social isolation and/or loneliness that would be feasible during COVID-19 shielding measures; 3) a relevant control group; and 4) quantitative measures of social isolation, social support or loneliness. At least two authors independently screened studies, extracted data, and assessed risk of bias using the Downs and Black checklist. Study registration: PROSPERO CRD42020178654. We identified 45 RCTs and 13 non-randomised controlled trials; none were conducted during the COVID-19 pandemic. The nature, type, and potential effectiveness of interventions varied greatly. Effective interventions for loneliness include psychological therapies such as mindfulness, lessons on friendship, robotic pets, and social facilitation software. Few interventions improved social isolation. Overall, 37 of 58 studies were of "Fair" quality, as measured by the Downs & Black checklist. The main study limitations identified were the inclusion of studies of variable quality; the applicability of our findings to the entire population; and the current poor understanding of the types of loneliness and isolation experienced by different groups affected by the COVID-19 pandemic.

CONCLUSIONS

Many effective interventions involved cognitive or educational components, or facilitated communication between peers. These interventions may require minor modifications to align with COVID-19 shielding/social distancing measures. Future high-quality randomised controlled trials conducted under shielding/social distancing constraints are urgently needed.

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

OBJECTIVES

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

DESIGN

Scoping review.

SETTINGS AND PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

A systematic review of interventions for loneliness among older adults living in long-term care facilities

OBJECTIVES

This study aimed to review loneliness interventions for older adults living in long-term care (LTC) facilities over the past 10 years, to categorize interventions by type, and to compare effectiveness of loneliness interventions in these settings.

METHODS

Systematic review followed PRISMA guidelines. Articles matching search criteria were collected from PubMed, PsycINFO, and Web of Science from 2009 to 2019. The inclusion criteria were as follows: 1) English language, 2) intervention studies with a quantitative measure that compares pre-trial to post-trial changes, 3) loneliness as a primary or secondary outcome 4) subjects age >65, and 5) subjects living in a LTC facility, such as a nursing home, assisted-living, or hospice.

RESULTS

A total of 15 intervention studies qualified for systematic review. Most of these interventions were psychological therapies and leisure/skill development interventions. Approximately, 87% of studies reported significant decreases in loneliness following intervention. Laughter therapy, horticultural therapy, and reminiscence therapy were associated with the greatest decreases in loneliness.

DISCUSSION

Results suggest that, although less common than interventions in the community, there are several effective interventions to reduce loneliness among older adults living in LTC facilities. Lack of standardized measures and high-quality studies limits comparisons between intervention types and generalizability to different populations.

A systematic review of the effect of laughter yoga on physical function and psychosocial outcomes in older adults

BACKGROUND

Laughter yoga is one of the increasingly used methods among complementary health approaches in the world. The aim of this study was to determine the effectiveness of laughter yoga on physical function and psychosocial outcomes in older adults.

METHODS

In this systematic review, electronic searches were performed in CINAHL, Web of Science, COCHRANE, Scopus, ProQuest databases from May 2010 to May 2020. The screening process was conducted by two authors independently and finally agreed together. The review was reported according to PRISMA guideline.

RESULTS

A total of 3210 studies were examined, and seven publications (six quasi experimental and one randomized control trial), in accordance with the inclusion criteria were included in the study and evaluated. The results indicated that significant differences were found in the effectiveness of laughter yoga on physical function (blood pressure, cortisol level, sleep quality) and psychosocial health (life satisfaction, quality of life, loneliness, death anxiety, depression, mood, happiness) in older adults.

CONCLUSION

Laughter yoga is a cost-effective and no adverse effect in older adults. It can be used for health promotion for older adults.

Relationship Between Religious Orientation and Death Anxiety in Elderly Individuals

This study aims to identify the relationship between religious orientation and death anxiety in elderly individuals aged 65 and over. This study is cross sectional in nature. It was conducted with the participation of 250 individuals aged 65 and over who were registered in Family Health Centers in the city center located in the eastern part of Turkey between February and June, 2018. The participants' Religious Orientation Scale mean score was found to be 53.03 ± 9.91, and Religious Orientation Scale mean score was found to be significantly higher in married people, in graduates of high school, in those who had social security, and in those who lived with their spouse (p < 0.01). Death Anxiety Scale mean score was found to be 7.73 ± 2.28, and Death Anxiety Scale mean score was significantly higher in those who lived with their children (p < 0.05). No statistically significant relationship was found between Death Anxiety and Religious Orientation. Elderly individuals were found to have high religious orientation and death anxiety. It is recommended that the factors that increase death anxiety should be identified, interventions should be provided to decrease these factors, and elderly people should be provided with social services for their religious needs.

Ansiedade relacionada à morte em cuidados paliativos: validação do diagnóstico de enfermagem

Resumo Objetivo: Identificar a prevalência do diagnóstico de enfermagem ansiedade relacionada à morte da NANDA-I em cuidadores familiares de doentes paliativos; e validar as características definidoras associadas. Métodos: Estudo transversal, exploratório e descritivo utilizando o Modelo de Validação Clínica de Fehring, em uma amostra de 111 cuidadores familiares de doentes paliativos. Foi calculada a sensibilidade, especificidade e valor preditivo das características definidoras. As questões formuladas para operacionalizar as características definidoras foram validadas por um painel de peritos. Resultados: A prevalência do diagnóstico foi de 38,7% na amostra estudada. Foram alvo de validação clínica 17 características definidoras, oito delas emergiram de uma prévia revisão da literatura. Nove características foram classificadas como principais e oito secundárias. Conclusão: O diagnóstico foi validado em cuidadores familiares de doentes paliativos. A validação clínica de novas características definidoras confirmou a necessidade da sua revisão de modo a estar adequado à clínica. A prevalência do diagnóstico na amostra estudada, indica que este é um fenômeno relevante a que os profissionais devem estar particularmente atentos, de modo a implementar intervenções específicas para minimizar a ansiedade relacionada à morte dos cuidadores familiares de doentes paliativos.