Well-Being and Institutional Care in Older Adults: Cross-Sectional and Time Effects of Provided and Received Support

Experimental paradigm to test the effects of providing social support: study protocol of the PROSPECT trial (Study 2)

BACKGROUND

A growing body of research suggests that the provision of social support can have benefits not only for the recipients but also for the provider. Although initial evidence for affective, self-evaluative and physiological outcomes has been established, the beneficial effects of support provision do not occur consistently across all support interactions, and some interactions may even have detrimental effects on providers. The aim of our experimental paradigm is to enable researchers to test the conditions under which the provision of social support to dyadic partners affects affective, self-evaluative, physiological, and relationship outcomes for the provider. In line with self-determination theory, it is proposed that the provision of support is only beneficial to the provider if it satisfies the three basic psychological needs of autonomy, competence and relatedness. The paradigm allows for the manipulation of the provider's levels of competence (feedback on the effectiveness of their support to the other person) and relatedness (feedback on the alleged level of relatedness perceived by the partner person following the provision of support).

METHODS

A priori power analyses resulted in a planned sample size of 250 participants randomized to four conditions: 1) no support provision, 2) support provision without feedback, 3) support provision with feedback on competence, 4) support provision with feedback on relatedness. Primary outcomes are immediate physiological (saliva cortisol, heart rate, heart rate variability, blood pressure), affective (positive and negative affect, anxiety), self-evaluative (e.g., self-esteem) and relationship outcomes. Generalized linear models will be used to compare the four conditions.

DISCUSSION

In a controlled laboratory experiment, this new experimental paradigm manipulates the conditions under which social support is provided. Insights into the conditions under which the provision of social support is detrimental or beneficial to the provider can inform the development of preventive and interventional approaches across a range of life domains, motivational and developmental research across the lifespan (e.g. prevention of care-giver burnout), and applied clinical contexts (e.g. therapeutic interventions).

TRIAL REGISTRATION

Pre-registration (2023-11-10): https://doi.org/10.17605/OSF.IO/8SPZW , retrospective registration with more details (2024-10-23): https://www.drks.de/DRKS00034287.

What interventions keep older people out of nursing homes? A systematic review and meta-analysis

BACKGROUND

Nursing home admission remains a central outcome in many healthcare systems and community-based programs. The objective of this meta-analysis was to determine the efficacy of pharmacological and nonpharmacological interventions in preventing nursing home admission for adults aged 65 years or older.

METHODS

MEDLINE, EMBASE, PsycInfo, CINAHL, and the Cochrane Library were all last searched in March 2022 to identify up-to-date eligible studies for the meta-analysis. Two reviewers screened each abstract independently. In instances where reviewers disagreed as to inclusion, all reviewers convened to review the Abstract to come to a consensus decision regarding inclusion. Two reviewers independently collected data from each report. Disagreements were resolved using group consensus. The first author reviewed the narrative descriptions of intervention components to create a categorization scheme for the various interventions evaluated in selected studies. These categorizations were reviewed with the co-authors (second-fifth) and collapsed to create the final classification of intervention type. Study risk of bias was assessed using an instrument developed based on Agency for Healthcare Research & Quality (AHRQ) guidance. Differences between the percentages of participants in treatment versus control arms was the outcome of interest.

RESULTS

Two-hundred and eighty-three studies with a total of 203,735 older persons were included in the meta-analysis. Specialty geriatrics care (OR = 0.77, 95% CI, 0.60-0.99), multicomponent interventions (OR = 0.82, 95% CI, 0.67-0.99), and cognitive stimulation (OR = 0.60, 95% CI, 0.38-0.96) were associated with less frequent nursing home admission. Home-based and inpatient/discharge management interventions approached statistical significance but were not associated with reduced institutionalization.

CONCLUSIONS

Even in the face of complex care needs, older adults wish to live at home. Effectively disseminating and implementing geriatric care principles across healthcare encounters could achieve a highly valued and preferred outcome in older adulthood: aging in place.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Predictors of pretraumatic stress during the COVID-19 pandemic in Poland

BACKGROUND

Pretraumatic stress has the same symptoms as post-traumatic stress but instead pertains to anticipated threats. There is evidence that pretraumatic stress occurs among soldiers and pregnant people.

OBJECTIVE

We analyzed correlates of pretraumatic stress concerning the threat of COVID-19 infection.

METHOD

Our pilot study was cross-sectional (N = 74); our main study was longitudinal and consisted of three waves (N = 1067, N = 894, and N = 752 for Waves 1, 2, and 3, respectively). Our pilot study used correlation and multiple linear regression. Our main study used quadratic regression and a random intercept cross-lagged panel model.

RESULTS

The pilot study found that pretraumatic stress was positively correlated with agreeableness (r = .24, p < .01) and negatively correlated with emotional stability (r = -.30, p < .01) and intellect/imagination (r = -.37, p < .01). The main study demonstrated that pretraumatic stress was positively correlated with other measures of mental health problems during the COVID-19 pandemic and with perceived positive aspects of the pandemic (r = .11, p < .01). There is evidence of a U-shaped relationship between pretraumatic stress and perceived positive aspects of the pandemic. A random intercept cross-lagged panel model analysis demonstrated that pretraumatic stress in Wave 2 was negatively predicted by levels of prosocial behavior in Wave 1 (B = -1.130, p < .01).

CONCLUSION

Mental health professionals should take into account pretraumatic stress, not only as a possible consequence of the COVID-19 pandemic outbreak but more generally as a risk in situations that are new, difficult, and challenging for people.

An exploration of happiness, anxiety symptoms, and depressive symptoms among older adults during the coronavirus pandemic

The COVID-19 pandemic has affected millions of people worldwide. Because of the challenges associated with the pandemic, universal levels of happiness have likely depleted. We know little about how those with prior existing mental health concerns have responded to the pandemic. Using cross-sectional (study 1; N = 1,366) and longitudinal (study 2; N = 262) data, we utilized a stress and resilience perspective to explore mental health symptoms and happiness among older adults before and after the declaration of the pandemic. Results for both studies indicated higher levels of depression and anxiety symptoms predicted lower levels of happiness; however, for those who indicated higher levels of mental health symptoms, post-pandemic declaration happiness levels were higher than pre-pandemic happiness levels. Findings suggest that resilience may be learned throughout a lifetime, and that experiences from prior stressors may show benefits in responding to future ones, even among vulnerable populations.

Informal Care and Subjective Well-Being among Older Adults in Selected European Countries

A person’s health status is one of the strongest determinants of well-being. The negative impact of poor health on subjective well-being may be moderated by providing care to individuals in need. In this paper, we investigate the relationships between receiving informal care and the amount of care received and subjective well-being among people aged 65 or older in selected European countries. Our analysis of data from the 6th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) showed that receiving regular informal care was associated with higher subjective well-being among older people in Northern European countries, and with lower subjective well-being among older males in Southern European countries. Moreover, we found that the perception of the amount of help received affected the subjective well-being of older people, as those who reported that the support they received was either insufficient or met their needs had lower subjective well-being than those who were not in need of care. Our results also showed that receiving formal care was negatively related with subjective well-being among older adults in Northern Europe and Central and Eastern Europe. In the context of population ageing and the growing need for care, social policies that support both sides of the caregiving relationship could enhance subjective quality of life.

Making the Decision to Stay at Home: Developing a Community-Based Care Process Model for Aging in Place

The care of older adults who wish to spend their old age at home should be regulated in every country. The purpose of this article is to illustrate the steps for developing a community-based care process model (CBCPM), applied to a real-world phenomenon, using an inductive, theory-generative research approach to enable aging at home. The contribution to practice is that the collaboration team experts facilitate the application of the process in their own work as non-professional human resources. This means that each older adult is his or her own case study. Different experts and non-experts can engage in the process of meeting needs as required. The empirical work examined the number of levels and steps required and the types of human resources needed. The proposed typology of the CBCPM for older adults can provide insight, offer a useful framework for future policy development, and evaluate pilots at a time when this area of legislation is being implemented.

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.

Optimism and social support moderate the indirect relationship between self-efficacy and happiness through mental health in the elderly

We examined the role of self-efficacy, social support, optimism, and mental health in the prediction of happiness in the elderly. Moderated mediation analyses confirmed a full mediation in which self-efficacy, through perceived mental health and moderated by social support, predicts happiness moderated, in turn, by optimism. When an elder is self-efficacious, his or her mental well-being seems more likely to be improved and translated into enhanced happiness when social support and optimism are moderate to high. We provide preliminary results on the interplay of these psychosocial resources in improving subjective well-being that may help in designing tailored interventions for promoting happiness in late adulthood.

Psychosocial Resources for Hedonic Balance, Life Satisfaction and Happiness in the Elderly: A Path Analysis

We explored possible paths from physical and mental health-related quality of life, self-efficacy, optimism, and social support to happiness in older adults, considering hedonic balance and life satisfaction as mediators. A total of 154 Spanish male and female (50%) older adults (65–96 years old, M = 77.44, SD = 8.03; 64% noninstitutionalized elderly) voluntarily participated in this correlational, cross-sectional study. The participants completed self-reports on their perceived health status, self-efficacy, social support, optimism, and global subjective well-being (SWB) as well as its dimensions. Path analysis was used to examine direct and indirect relationships. The final model had an excellent fit with the data (χ2(10) = 11.837, p = 0.296, χ2/df = 1.184; SRMR = 0.050, CFI = 0.994, RMSEA = 0.035), revealing the unique causal effects of all the included predictors on happiness. With the exception of self-efficacy, the psychosocial resources predicted older adults’ current happiness, and this relationship was fully mediated by hedonic balance and life satisfaction, which were found to be putative intermediary factors for SWB. Self-efficacy in turn predicted the remaining psychosocial resources. Our findings extend the existing evidence on the influences of health-related quality of life, self-efficacy, optimism, and social support on SWB. Furthermore, they support the proposal of hedonic balance and life satisfaction as dimensions of SWB, thus supporting the tripartite hierarchical model of happiness. These results may inform future interventions seeking to improve happiness in late adulthood.

Coping Flexibility and Health-Related Quality of Life Among Older Adults: The Compensatory Effect of Co-rumination

Background: Coping flexibility, defined as a wide range of coping strategies, may be a promising construct in determining coping effectiveness, especially in conjunction with a person-centered approach. However, no studies have focused on these issues. The study aimed to identify the distinct, multidimensional patterns of strategies for coping with chronic health conditions and their association with changes in physical and psychological health-related quality of life (HRQoL) among older adults over a one month period.

Methods: Coping strategies (brooding, reflection, co-rumination, and positive reappraisal) and HRQoL psychological and physical domains were assessed twice (at the baseline and one month later) among 210 older adults (age 76.12 ± 9.09 years, 66% women).

Findings: The parallel process analysis demonstrated the sample heterogeneity regarding coping. In multidimensional latent class growth analysis (MLCGA), four coping classes of overall strategies were identified: consistently low (46%), medium and decreasing (18%), medium and increasing (20%), and consistently high (16%). The last two can be considered the coping flexibility. Participants in the medium and increasing subgroup reported enhancement in HRQoL psychological domain, whereas members of the consistently high subgroup indicated its decrease. The favorable effects were related to an increase in co-rumination.

Discussion: The findings shed light on the longitudinal patterns of coping in older adults, showing that coping flexibility is more adaptive when it relies on modifying coping efforts rather than coping complexity. Co-rumination played a key role, compensated by the effect of maladaptive strategies.

A longitudinal analysis of posttraumatic growth and affective well-being among people living with HIV: The moderating role of received and provided social support

Objectives

The aim of this one-year longitudinal study was to examine the temporal relationship between the level of posttraumatic growth (PTG) and affective well-being, measured by the presence of positive and negative affect among people living with the HIV (PLWH). In addition, the moderating effects of received and provided support with respect to the above-mentioned relationship were investigated.

Method

Study participants completed the following psychometric inventories: the Posttraumatic Growth Inventory (PTGI), the Positive and Negative Affect Schedule (PANAS-X), and the Berlin Social Support Scales (BSSS). Three assessments were performed: 129 patients were recruited for the first assessment, 106 patients agreed to participate in the second assessment, and 82 of the initial 129 participants (63.6%) participated in all three assessments.

Results

An indirect association between PTG and positive affect was observed. However, no association was found between PTG and negative affect. Received support, but not provided support, completely moderated the relationship between PTG and positive affect.

Conclusions

This study adds to the literature by examining the temporal relationship between PTG and affective-wellbeing among PLWH. It appears from the results that in this patient group, PTG may enhance the positive affect over time. However, receiving support is vital in this process.

Paradoxical effect of social support among people living with HIV: A diary study investigating the buffering hypothesis

OBJECTIVE

The aim of this study was to examine the buffering role of time-varying received and provided support in the relationship between stress and end-of-day mood among people living with HIV. In addition, the moderating role of intimate relationships in this buffering effect was verified.

METHODS

The participants included 115 patients with a confirmed diagnosis of HIV infection. The data were collected using an online diary method. For five consecutive days (from Monday to Friday), participants completed an online time-stamped questionnaire in the evening to assess their end-of day-mood, stress related to a central hassle on any given day and social support that was received and provided.

RESULTS

The results of the multilevel analysis showed that daily provided, but not received, support had the following partial buffering effect: the association between negative affect and stress was weaker on days with higher support provision. However, this effect was limited to those participants who were in an intimate relationship; the opposite effect was observed in single participants.

CONCLUSION

These findings suggest that the buffering effect of daily support may be modified by other social resources, such as being in an intimate relationship, and when they are not available, it can even become detrimental.