Betekenis van huisdieren in de langdurige thuiszorg

Achtergrond: Huisdieren zijn belangrijk in het leven van thuiswonende ouderen en van degenen die langdurige thuiszorg (LTZ) ontvangen. Het doel van dit project was om de betekenis van huisdieren voor thuiswonende ouderen te verkennen en te onderzoeken of deze ook van toepassing zijn op LTZ-cliënten. Daarnaast exploreerden we mogelijke huisdiergerelateerde uitdagingen en de invloed van huisdierbezit op zorgrelaties in de LTZ. Methoden: Het project startte met een systematische kwalitatieve literatuur review gevolgd door een studie met de Consensual Qualitative Research (CQR) methode en een onlinevragenlijst om de resultaten van de review in de LTZ te toetsen. LTZ-cliënten, mantelzorgers en professionele zorgverleners namen deel aan de CQR-studie en vragenlijst. De vragenlijst bevatte daarnaast open vragen over mogelijke huisdiergerelateerde uitdagingen en hun invloed op zorgrelaties in de LTZ. Resultaten: De review bevatte vijftien artikelen die achtentwintig rollen gerelateerd aan de betekenis van huisdieren beschreven, onderverdeeld in zeven categorieën. De uitkomsten van de CQR-studie en vragenlijst toonden dat huisdieren een vergelijkbare betekenis hebben voor thuiswonende ouderen en LTZ-cliënten. Deelnemers rapporteerden mogelijke uitdagingen en zowel positieve als negatieve effecten van huisdieren op zorgrelaties. Conclusies: Huisdieren hebben een vergelijkbare betekenis voor thuiswonende ouderen en LTZ-cliënten. Bovendien ervaren LTZ-cliënten mogelijke specifieke huisdiergerelateerde uitdagingen en kunnen huisdieren zorgrelaties beïnvloeden. Daarom is het noodzakelijk om rekening te houden met huisdieren in de LTZ.

The roles of pets in long-term care at home: a qualitative study

BACKGROUND

Pets play very important roles for older adults. However, whether the same roles apply to pets of care clients receiving long-term care at home (LTCH) is unclear. This study aimed primarily to explore whether the roles of pets for LTCH-clients who own pets are comparable to the roles of pets for older adults in the general population. Furthermore, we explored potential pet-related problems that might be encountered in LTCH in practice, and the potential influences of pet ownership on caregiving relationships. These insights may help improve long-term care services in LTCH.

METHODS

This project started with a study using the Consensual Qualitative Research method (CQR). We conducted semi-structured interviews based on themes from our previous review (e.g., Relational Aspects, Emotional Aspects, and Social Aspects). Secondly, an online survey was used to confirm the findings from the CQR study by calculating Content Validity Index scores (in SPSS 26) regarding contents, relevance, and clarity. The survey also included open-ended questions on potential pet-related problems and their impact on caregiving relationships for LTCH-clients, family caregivers, and professional caregivers.

RESULTS

The CQR study found that the roles pets play for LTCH-clients (N = 8), family caregivers (N = 10), and professional caregivers (N = 10) were similar to the roles pets play for older adults in the general population. The online survey confirmed most of the CQR findings. In the survey, LTCH-clients (N = 4), family caregivers (N = 8), professional caregivers (N = 8), and researchers in human-animal studies and in geriatric care (N = 5) reported various potential problems that could arise from pet ownership by LTCH-clients, such as clients with deteriorating health being forced to part with their pets. Participants also reported potential positive and negative effects of pet ownership on caregiving relationships, such as pets being a nice topic of conversation, or, conversely, a source of disagreement in the LTCH context.

CONCLUSIONS

The roles pets play for LTCH-clients seem comparable to the roles pets play for older adults in the general population. In addition, LTCH-clients might experience pet-related problems specific to the LTCH context. Pets may influence caregiving relationships, either positively or negatively. Therefore, instruments and guidelines are needed to account for pets in LTCH.

Children's bond with companion animals and associations with psychosocial health: A systematic review

Background

Companion animals can fulfill children's attachment needs. A secure attachment to humans is positively associated with psychosocial health, therefore, the extent to which this applies to a strong child-companion animal bond is worth examining.

Aims

We aimed to gain insight into the current literature regarding the bond between children and companion animals and psychosocial health. Secondary, we also synthesized evidence about the (1) characteristics of children and companion animals and the strength of their bond; (2) the correlations between attachment to humans and the child-companion animal bond; and (3) the instruments used to measure the child-companion animal bond.

Method

According to PRISMA guidelines, we searched three major electronic databases (PubMed, EBSCOhost, and Web of Science) in September 2021 and included records with the following criteria: peer reviewed English articles with quantitative and qualitative data on child-companion animal bonds and children's psychosocial health. Reports with participants younger than 18 years of age with a family owned companion animal were included. Two authors performed the screening and determined eligibility according to a predefined coding protocol.

Results

The search revealed 1,025 unique records, of which we included 29 studies. Some positive associations were reported between the strength of the child-companion animal bond and children's psychosocial health outcomes like empathy, social support, and quality of life, although some results were contradictory. We found differences in associations between a child's gender, companion animal species and the strength of the child-companion animal bond. A secure attachment style to parents was positively associated with a stronger child-companion animal bond. Most of the instruments currently used, measure the strength of the bond.

Discussion

This review suggests that the child-companion animal bond could be beneficial for children's psychosocial health, but some results were inconclusive. Also, not every relationship develops into an attachment. Since a strong bond with animals might not be the same as a secure attachment, we advise to modify human attachment instruments, in order to effectively study children's attachment to companion animals. Lastly, research designs that are able to investigate the causality of the relationship between the child-companion animal bond and psychosocial health are required.

The role of pets in the support systems of community-dwelling older adults: a qualitative systematic review

OBJECTIVE

Western countries face ageing populations and increasing numbers of older adults receiving long-term care at home (home care). Approximately 50% of households in Western countries own pets, and while pets impact the health and wellbeing of their owners, most healthcare organisations do not account for the role of pets in the lives of their clients. Due to the lack of research in older adults receiving home care that own pets, this study aimed to review previous qualitative research about the role and significance of pets for older adults in general.

METHOD

PubMed and PsycINFO were systematically searched with variations on (MeSH) terms for older adults (mean age 65 years and older), pets, and qualitative study designs. Iterative-inductive thematic analyses were performed in ATLAS.ti.

RESULTS

We included fifteen studies and extracted twenty-eight themes within seven categories: Relational Aspects, Reflection and Meaning, Emotional Aspects, Aspects of Caregiving, Physical Health, Social Aspects, and Bidirectional Behaviour. Older adults reported not only on positive aspects of pet ownership such as the emotional support their pets provided but also on negative aspects such as postponing personal medical treatment.

CONCLUSION

Older adults perceived pets as important for their health and wellbeing. This implies that care workers may be able to improve home care by accounting for the role of pets of older adults receiving home care. Based on our findings, we suggest that community healthcare organisations develop guidelines and tools for care workers to improve care at home for clients with pets.

The Relevance of Internal Working Models of Self and Others for Equine-Assisted Psychodynamic Psychotherapy

Attachment characteristics play a key role in mental health and in understanding mental disorders. The aim of this study was to gain insight into the role the attachment characteristics can play in treatment effects in adult patients with intrapsychic and interpersonal problems who underwent Equine-assisted Short-term Psychodynamic Psychotherapy (ESTPP). In the first part of the study, we compared the effects of ESTPP to treatment-as-usual from a previous dataset regarding psychological dysfunction. For this, an explorative experimental non-randomized pre-treatment and 1-year post-treatment design was used. A mixed model revealed a significant decline in psychological dysfunction for both conditions, with no significant difference between the two. In the second part of the study, we examined the course of ESTPP effects over the period of 1 year when controlled for attachment styles and, subsequently, for internal working models of self and others. To this end, measurements were taken at baseline, 2 months waiting time, one-week intensive module, 6 months, and one year after the start of the treatment. Mixed models accounted for repeated measures showed significant improvements in psychological dysfunction, remoralization, and depression for ESTPP patients over time. The study implies that models of self and others may be used to predict the course of effects, which is relevant in determining what works for whom. In particularly, duration and intensity of therapy and a focus on the Model of Self seem relevant for shaping a more personalized treatment. ESTPP seems beneficial for patients with low pre-treatment attachment security.

[Remote work and the use of online communication in nursing homes during COVID-19-measures]

The measures taken in Dutch nursing homes during the first wave of the COVID-19 pandemic resulted in both an increase and a decrease of challenging behavior in nursing home residents. Staff undertook various initiatives to reduce the negative effects. For example, video calling between residents and their relatives was facilitated. In addition, initiatives in digital care (telehealth) were deployed. The aim of this study was to explore nursing home practitioners' experiences with online communication between residents and relatives, working remotely in general and the remote treatment of challenging behavior in particular. One hundred and seventy-five nursing home professionals (psychologists, elderly care specialists, nursing specialists, daytime activities coordinators) completed an online questionnaire at the end of 2020/start of 2021. Open and closed questions showed that face-to-face contacts are preferred over online communication. Online communication was mainly seen as a (meaningful) addition. Although professionals wanted to continue some of their work remotely, and found this efficient and workload-reducing, they felt that this could impair their job satisfaction and the quality of care. For remote work and remote treatment, each task needs to be evaluated on whether it can be performed properly and whether that results in good care. More research into online communication, remote working and digital care in nursing homes is needed.

[Consequences of the COVID-19 measures for wellbeing aspects of long-term care residents]

To examine the impact of COVID-19 measures on residents of long-term care institutions, two surveys were conducted in the spring of 2020. Leontjevas et al. (study 1) inventoried practitioners' opinions, Van der Roest et al. (study 2) opinions of care workers, family, and residents without severe cognitive impairments. This article describes the combined results on social interaction and loneliness, challenging behaviour and mood, and lessons learned. In study 1, an online survey distributed to nursing home psychologists, they were asked to complete it anonymously and share the link with their fellow elderly care physicians and nurse specialists. 16 participants were then interviewed via video calling. In study 2, three hundred and fifty-seven care organizations were invited to recruit residents without severe cognitive impairments, family members and care workers for participating in a digital, anonymous survey (Study 2). The completed surveys of 323 practitioners (study 1) and 193 residents, 1609 family members and 811 employees (study 2) were included in the analyses. Social contacts of residents had changed in frequency and form compared to before the COVID-measures. Many residents experienced some loneliness during the visit ban, especially residents without cognitive impairments. There were both an increase and a decrease in challenging behaviour and affect. Several strategies used to reduce the effects of COVID-19 measures on well-being, were considered maintainable. Our studies confirmed a major impact of the COVID-19 measures on the wellbeing of long-term care residents, but also showed successful strategies of practitioners that can benefit future practice.

Effect of one year krill oil supplementation on depressive symptoms and self-esteem of Dutch adolescents: A randomized controlled trial

INTRODUCTION

Observational studies have shown a relationship between omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) and depression in adolescents. However, n-3 LCPUFA supplementation studies investigating the potential improvement in depressive feelings in adolescents from the general population are missing.

METHODS

A one-year double-blind, randomized, placebo controlled krill oil supplementation trial was conducted in two cohorts. Cohort I started with 400 mg eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or placebo, after three months this increased to 800 mg EPA and DHA per day, whilst cohort II started with this higher dose. Omega-3 Index (O3I) was monitored via finger-prick blood measurements. At baseline, six and 12 months participants completed the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Rosenberg Self Esteem questionnaire (RSE). Adjusted mixed models were run with treatment allocation/O3I as predictor of CES-D and RSE scores.

RESULTS

Both intention-to-treat and assessing the change in O3I analyses did not show significant effects on CES-D or RSE scores.

CONCLUSION

There is no evidence for less depressive feelings, or higher self-esteem after one year of krill oil supplementation. However, due to a lack of adherence and drop-out issues, these results should be interpreted with caution.

[The use of guidelines for depression care in nursing homes in association with experienced competence, autonomy and relatedness by professionals]

Depression is highly prevalent in nursing homes residents and affects their quality of life. Both prevalence and impact of depression may decrease when effective guidelines or depression care programs are used, but this appears to be a challenging task. The Self Determination Theory postulates that the realization of complex tasks is being facilitated by meeting three basic human psychosocial needs: autonomy, competence and relatedness to others. This cross-sectional study investigates the relationship between the experienced autonomy, competence and relatedness and the extent to which depression care is given according to guidelines in 46 doctors, 49 psychologists and 53 nurses from 71 Dutch nursing homes. Although autonomy and competence were significantly related to depression care according to guidelines, hierarchical multiple regression analyses with all three basic needs showed a statistically significant result for competence only. The associations don't allow conclusions about causal relationships, longitudinal research will shed light on the direction of the association for competence.

Correction to: Exploring the association between whole blood Omega-3 Index, DHA, EPA, DPA, AA and n-6 DPA, and depression and self-esteem in adolescents of lower general secondary education

The original version of this article unfortunately contained a mistake. Title was incorrect.

Towards an assessment instrument for suffering in patients with psychiatric conditions: assessing cognitive validity

BACKGROUND

Unbearable suffering is a key criterion in legally granting patients' euthanasia requests in Belgium yet a generally accepted definition of unbearable suffering remains elusive. The ability to understand and assess unbearable suffering is essential, particularly in patients with psychiatric conditions, as the underlying causes of these conditions are not always apparent. To enable research into when and why suffering experiences incite patients with psychiatric conditions to request euthanasia, and to help explore preventive and curative perspectives, the development of an assessment instrument is needed.

AIMS

To improve the cognitive validity of a large initial item pool used to assess the nature and extent of suffering in patients with psychiatric conditions.

METHOD

Cognitive validity was established via two rounds of cognitive interviews with patients with psychiatric conditions with (n = 9) and without (n = 5) euthanasia requests.

RESULTS

During the first round of cognitive interviews, a variety of issues relating to content, form and language were reported and aspects that were missing were identified. During the second round, the items that had been amended were perceived as sufficiently easily to understand, sensitive to delicate nuances, comprehensive and easy to answer accurately. Neither research topic nor method were perceived as emotionally strenuous, but instead as positive, relevant, comforting and valuable.

CONCLUSIONS

This research resulted in an item pool that covers the concept of suffering more adequately and comprehensively. Further research endeavours should examine potential differences in suffering experiences over time and in patients with psychiatric conditions with and without euthanasia requests. The appreciation patients demonstrated regarding their ability to speak extensively and openly about their suffering and wish to die further supports the need to allow patients to speak freely and honestly during consultations.

DECLARATION OF INTERESTS

None.

Exploring the association between whole blood Omega-3 Index, DHA, EPA, DHA, AA and n-6 DPA, and depression and self-esteem in adolescents of lower general secondary education

Purpose

Depression is common in adolescents and long-chain polyunsaturated fatty acids (LCPUFA) are suggested to be associated with depression. However, research in adolescents is limited. Furthermore, self-esteem has never been studied in relation to LCPUFA. The objective here was to determine associations of depression and self-esteem with eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), Omega-3 Index (O3I), n-6 docosapentaenoic acid (n-6 DPA, also called Osbond acid, ObA), n-3 docosapentaenoic acid (DPA), and arachidonic acid (AA) concentrations in blood of adolescents attending lower general secondary education (LGSE).

Methods

Baseline cross-sectional data from a krill oil supplementation trial in adolescents attending LGSE with an O3I ≤ 5% were analysed using regression models built with the BayesFactor package in R. Fatty acids and O3I were determined in blood. Participants filled out the Centre for Epidemiologic Studies Depression (CES-D) scale and the Rosenberg Self-Esteem scale (RSE).

Results

Scores indicative of depression (CES-D ≥ 16) were found in 29.4% of the respondents. Of all fatty acids, we found extreme evidence [Bayes factor (BF) > 100] for a weak negative association between ObA and depression score [− 0.16; 95% credible interval (CI) − 0.28 to − 0.04; BF₁₀ = 245], and substantial evidence for a weak positive association between ObA and self-esteem score (0.09; 95% CI, − 0.03 to 0.20; BF₁₀ = 4). When all fatty acids were put in one model as predictors of CES-D or RSE, all of the 95% CI contained 0, i.e., no significant association.

Conclusion

No evidence was found for associations of DHA, EPA and O3I with depression or self-esteem scores in LGSE adolescents with O3I ≤ 5%. The associations of higher ObA status with lower depression and higher self-esteem scores warrant more research.