Patterns of telephone use among nursing home residents

Assistive technologies that support social interaction in long-term care homes: a scoping review

OBJECTIVE

The objective of this review was to chart the literature on assistive technologies (excluding robots) that support social interaction of older adults in long-term care homes, and to advance a definition of socially assistive technologies.

INTRODUCTION

Loneliness and social isolation have adverse effects on the health and well-being of older adults. Many long-term care homes provide recreational programming intended to entertain or distract residents, yet the evidence of their effectiveness is limited. Absent from the literature are comprehensive reviews of assistive technologies (other than robots) that are used to support social interaction in long-term care homes.

INCLUSION CRITERIA

The review considered research studies as well as gray literature that included older adults (≥65 years) living in long-term care homes. The concept of interest was the use of assistive technologies (excluding robots) that support social interaction in long-term care homes.

METHODS

The databases were searched on June 26, 2019, and included CINAHL Full Text (EBSCO), MEDLINE (Ovid), PsycINFO (EBSCO), Sociological Abstracts (ProQuest), Embase (Elsevier), and Web of Science (Clarivate). The search for gray literature was conducted in ProQuest Dissertations and Theses Databases and across 11 websites during September and October 2019. The recommended JBI approach to study selection, data extraction, and data synthesis was used.

RESULTS

Twenty-five articles were included in this review, with comparable numbers of quantitative (n = 6), qualitative (n = 9), and mixed methods (n = 7) studies, with the remaining articles employing non-empirical designs (n = 3). Technologies were categorized as low (easily recognizable to everyone), medium (more electronics), or high (involves internet). Two studies reported on low-assistive technologies, including videotapes and the telephone. Medium-assistive technologies were identified in nine studies and included videophones; Nintendo Wii; tablet-based games; picture- and video-viewing tools; and CRDL (pronounced "cradle"), a special instrument that translates touch into sound. More than half (n = 14) of the included articles utilized high-assistive technologies, such as computer labs/kiosks, tablet-based applications, social media (eg, Facebook), videoconferencing, and multi-functional systems. Five studies measured whether assistive technologies had an impact on the quantity of long-term care residents' social interaction levels. Qualitative themes were related to residents' social connections and experiences after using various technologies. Four studies systematically incorporated a framework/model, and Social Structuration Theory was considered the most comprehensive. In the absence of a definition of socially assistive technologies, the definition advanced from this review is as follows: Socially assistive technologies are user-appropriate devices and tools that enable real-time connectivity to enhance social interaction.

CONCLUSIONS

Included literature reported the benefits of technology use, with considerable variability in engagement and no cost estimates. We recommend that future research continue to advance our definition of socially assistive technologies, make promising assistive technologies available in long-term care homes after studies are completed, report the costs of assistive technologies, and include participants with dementia and culturally and linguistically diverse backgrounds.

Barriers to the Use of Traditional Telephones by Older Adults with Chronic Health Conditions

As people age, they face motor, sensory, and cognitive decline that may compromise their performance of activities of daily living and instrumental activities of daily living. Telephone use is an important instrumental activity of daily living for older adults, but many have difficulty in making and receiving calls. Today, there are many features that can be added to the telephone that can help compensate for impairments, but often these features are not used. To better understand the problems of older adults in using their telephones, we surveyed 609 older adults living in the community who had chronic health conditions. Interviews were conducted face-to-face, by telephone, or by mail. The most common reasons for not using more telephone special features were cost, lack of perceived need, and lack of knowledge of the features. Occupational therapists who work with older adults must understand the importance of telephones in their lives and offer them information and assistance in finding telephones with features that match their special needs. The findings of this study suggest that a significant number of older adults with chronic health conditions are unaware of low-cost, feature-laden telephones that could make their communications easier or, for some, possible.

Management of persistent pain in the older patient: a clinical review

IMPORTANCE

Persistent pain is highly prevalent, costly, and frequently disabling in later life.

OBJECTIVE

To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult.

EVIDENCE ACQUISITION

Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults.

FINDINGS

Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended-emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician.

CONCLUSIONS AND RELEVANCE

Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.

Connectedness in Community-Dwelling Older Adults

The purpose of this study was to examine the processes involved with connectedness in community-dwelling older adults, which the authors contend is quality of life from a generative perspective. Using a grounded theory approach, 12 older adults were interviewed using a semistructured interview guide. The tape-recorded interviews were transcribed verbatim, categories were created to code the data, and themes were extracted. Four processes involved with connectedness in older adults were identified: (a) having something to do, (b) having relationships, (c) having a stake in the future, and (d) having a sense of continuity. Various aspects of spirituality were also apparent in each of the four processes. This study suggests that connectedness provides older adults with a mechanism to engage life in meaningful, positive, and purposeful ways.

A middle range theory for generative quality of life for the elderly

Decades of quality of life (QOL) research has failed to produce widely recognized QOL definitions or measurements. The inconsistency may be due to an ontological error in the perspective of researchers. Most researchers portray QOL as a given or inherent condition that declines in the face of challenges. We believe QOL is a cumulative process that results from a series of connections and disconnections that elders experience in their daily lives. The Register theory of Generative Quality of Life for the Elderly offers an alternative ontological perspective by placing elder QOL in a generative context.