The need for a social revolution in residential care

Prediction of Social Engagement in Long-Term Care Homes by Sex: A Population-Based Analysis Using Machine Learning

The objective of this study was to use population-based clinical assessment data to build and evaluate machine-learning models for predicting social engagement among female and male residents of long-term care (LTC) homes. Routine clinical assessments from 203,970 unique residents in 647 LTC homes in Ontario, Canada, collected between April 1, 2010, and March 31, 2020, were used to build predictive models for the Index of Social Engagement (ISE) using a data-driven machine-learning approach. General and sex-specific models were built to predict the ISE. The models showed a moderate prediction ability, with random forest emerging as the optimal model. Mean absolute errors were 0.71 and 0.73 in females and males, respectively, using general models and 0.69 and 0.73 using sex-specific models. Variables most highly correlated with the ISE, including activity pursuits, cognition, and physical health and functioning, differed little by sex. Factors associated with social engagement were similar in female and male residents.

A mixed methods feasibility study of a virtual group-based social support program for older adults in residential care

OBJECTIVES

In response to calls for inventive ways to mitigate risks of physical distancing due to the COVID-19 pandemic for older adults living in residential care, the JAVA Music Club-Digital (JMC-D) was developed. The current feasibility study investigated benefits, usability, and implementation of weekly JMC-D sessions over 6 months.

METHOD

Employing a pre-post mixed methods study, depressive symptoms, loneliness, social isolation, and quality of life were measured at baseline, 3 and 6 months. Qualitative interviews were conducted at 3 months.

RESULTS

Twenty-one residents were recruited. Across the three time points there was a large effect for depressive symptoms, social isolation, and quality of life, though not statistically significant. There was a significant immediate increase in happiness following engagement in the JMC-D sessions. Thematic analysis of semi-structured interviews generated two overarching themes: Experiencing the JMC-D (subthemes: Benefits, Navigating the virtual platform, Feedback) and Considerations for Implementation (subthemes: Perceived purpose, Characteristics that impact the experience, and Infrastructure and resources).

CONCLUSION

Findings are encouraging and suggest that the JMC-D may support emotional and other psychosocial indices of wellness in residential care during times of physical distancing. Appropriate staffing, resources, and internet accessibility are important for implementation and uptake.

How can care home activities facilitate social connection in residents? A qualitative study

OBJECTIVES

Good social connection is associated with better physical and mental health but care home residents experience barriers to social connection. Activities present a potential avenue for improving social connection in care homes but residents often experience loneliness despite access to activity programmes. We therefore aimed to identify what aspects of activities facilitate social connection in care home residents.

METHOD

Qualitative study using semi-structured interviews that were analysed using Thematic Analysis. A purposive sample of 35 participants, including 12 residents, 10 family caregivers, nine care home staff and four clinicians, recruited from UK care homes.

RESULTS

We found four main themes describing features of activities important for facilitating social connection: (1) personalisation with respect to residents' interests, social preferences, and cognitive ability; (2) activities which foster a sense of community; (3) finding and emphasising things in common that residents share; and (4) facilitating a sense of involvement with others.

CONCLUSION

We identified the key aspects of activities which facilitate social connection in care homes. These findings can be applied to a range of existing and newly designed activities in care homes and inform the development and testing of psychosocial interventions aiming to improve social connection.

Promoting resident thriving in nursing homes: A qualitative study

Aim

To explore how staff promote resident thriving in an Australian nursing home.

Design

Qualitative research design using content analysis.

Methods

Interviews were held with 14 nursing staff working in an Australian nursing home in March/April 2018. Data were analysed using qualitative content analysis.

Results

Four themes were revealed: promoting personalized care; promoting opportunities for autonomy; promoting connection and meaning; and promoting a curated environment.

Conclusions

Staff promoted resident thriving in relation to everyday care, activities, capabilities, relationships and the lived environment. Interventions that were perceived to promote thriving were described relative to the nurse, the resident, the care team and the wider nursing home context.

Implications for the Profession and/or Patient Care

The findings provide novel insight into the understanding and application of the concept of thriving in long‐term care from nursing staffs' perspective.

Impact

What Problem did the Study Address?

Nursing home staff are uniquely positioned to support resident thriving through person‐centred care, yet little is known about how staff support promotion of thriving for nursing home residents in their everyday practice.

What were the Main Findings?

Nursing home staff perceived that they promoted thriving by personalizing care and supporting autonomy, connection, meaning and pleasure for residents.

Where and on Whom will the Research have an Impact?

These findings are of interest for the clinicians, educators and researchers who develop, implement and evaluate interventions to improve place‐related well‐being in nursing homes.

Reporting Method

CORE‐Q checklist.

Patient or Public Contribution

No patient or public contribution occurred for this study as this research focused on exploring staffs' perspectives from the specific viewpoint of their personal experience.

Associations between social networks, cognitive function, and quality of life among older adults in long-term care

BACKGROUND

Having rich social networks is associated with better physical and cognitive health, however older adults entering long-term care may experience an increased risk of social isolation and consequent negative impacts on cognitive function. Our study aimed to identify if there is an association between accessing specific types of services or activities within long-term care on social networks and cognition.

METHODS

A cross-sectional study of 96 residents from 2 aged care providers in New South Wales, Australia. Residents were given a battery of assessments measuring social network structure (Lubben Social Network Scale, LSNS-12), quality of life (EuroQol 5D, Eq. 5D5L) and cognitive function (Montreal Cognitive Assessment, MoCA). Demographic factors and service use factors were also collected from aged care providers' electronic records. Independent sample t-test, ANOVA and linear regression analyses were used to explore associated factors for cognition.

RESULTS

Residents had a mean age of 82.7 ± 9.4 years (median = 81) and 64.6% were women. Most residents had cognitive impairment (70.8%) and reported moderate sized social networks (26.7/60) (Lubben Social Network Scale, LSNS-12). Residents who had larger social networks of both family and friends had significantly better cognitive performance. Service type and frequency of attendance were not associated with cognitive function.

CONCLUSIONS

Among individuals most at risk of social isolation, having supportive and fulfilling social networks was associated with preserved cognitive function. The relationship between service provision and social interactions that offer psychosocial support within long-term facilities and its impact over time on cognitive function requires further exploration.

You've Got E-Mail: A Pilot Study Examining the Feasibility and Impact of a Group-Based Technology-Training Intervention Among Older Adults Living in Residential Care

Older adults living in residential care often experience challenges in sustaining meaningful social relationships, which can result in compromised health and well-being. Online social networking has the potential to mitigate this problem, but few studies have investigated its implementation and its effectiveness in maintaining or enhancing well-being. This pilot study used a cluster-randomized pre-post design to examine the feasibility of implementing a 12-week group-based technology-training intervention for older adults (n = 48) living in residential care by exploring how cognitive health, mental health, and confidence in technology were impacted. Analysis of variance revealed significant increases in life satisfaction, positive attitudes toward computer use, and self-perceived competence among participants who received the intervention, but increased depressive symptoms for the control group. These findings suggest that, despite challenges in implementing the intervention in residential care, group-based technology training may enhance confidence among older adults while maintaining or enhancing mental health.

Perceived social support, loneliness, and depression among elderly living in old-age homes

Background

Older persons occasionally or permanently relocate from their own houses to institutions or old-age homes as a result of the current socio-demographic changes and circumstances. In this scenario, the current study aimed to assess the perceived social support, loneliness, and depression among the elderly living in old-age homes.

Materials and Methods

We have conducted a descriptive cross-sectional study among the elders living in old-age homes in Bengaluru urban, who have been staying in old-age homes for at least 6 months or above, and the age group of 60 years or above. Data were obtained from 40 respondents from four old-age homes using a simple random sampling method. Structured interview schedules have been used which included a socio-demographic profile, geriatric depression scale, multidimensional scale of perceived social support, and emotional and social loneliness scale.

Results

The majority of the respondents (82.5%) belonged to the age category of 60-70 years. More than half of the respondents were females (57.5%); 30% of the respondents were widowed. Nearly two-thirds of them belonged to below poverty line families. The analysis showed a negative correlation between perceived social support and loneliness and depression and a positive correlation between loneliness and depression. There is a significant gender difference among study variables such as perceived social support and depression. The results also show significant differences across the categories of socioeconomic status, duration of physical illness, and a number of organizations changed while comparing perceived social support and depression variables.

Conclusion

Perceived social support influences older adults' experience of loneliness and depression among inmates of old-age homes. Hence, there is a need to sensitize the staff working in old-age homes on caregiving skills for enabling the elderly to enjoy better-perceived social support and quality of life.

Impact of dance interventions on the symptoms of dementia: A mixed-methods systematic review

OBJECTIVES

This mixed-methods systematic review determined the impact of dance interventions on symptoms of Alzheimer's disease and related dementias (ADRD) among persons living in residential care.

METHODS

Seven databases (Medline, EMBASE, CINAHL, PsycINFO, Web of Science, Ageline, and AMED) were searched. Studies published before June 2022 that investigated the impact of dance interventions on symptoms of ADRD were eligible for inclusion. Risk of bias was assessed using CASP, ROBINS-I, and ROB-2. Quantitative and qualitative objectives provided a convergent segregate narrative synthesis for the review. The review protocol was registered on PROSPERO (CRD42021220535).

RESULTS

Two quantitative and two qualitative studies met the inclusion criteria. Dance interventions decreased levels of agitation and aggression, and improved behavioural and psychological symptoms.

CONCLUSIONS

Studies suggest that dance interventions reduce the symptoms of dementia through increased expression, emotions, and improved relationships for persons with ADRD. However, the small number of included studies limits these conclusions.

JAVA Memory Care program: Facilitating social and occupational engagement for older adults living with advanced dementia

BACKGROUND AND OBJECTIVES

Residents in aged care homes often report lack of life purpose and meaning and limited opportunities to contribute to their community. The JAVA Memory Care program is designed to facilitate engagement for older adults with advanced dementia. This study explored whether JAVA Memory Care engaged such adults meaningfully, on social and occupational levels, within one Australian residential care home.

METHODS

A mixed method design guided this exploration. Trained staff facilitated six JAVA groups over 2 months. Three sources of data were utilised. Observational data (qualitative and quantitative) were obtained using a narratively enhanced Assessment Tool for Social and Occupational Engagement (ATOSE). The other two data sources were qualitative and analysed thematically: reflections by the lead JAVA facilitator and data generated by a research discussion group.

RESULTS

The quantitative data comprised 564 ATOSE behaviour markers. Participants were categorised as being engaged in 93% of these markers. Two of the three qualitative themes focused on the collective and self-expressive nature of participant engagement. The third theme focused on practicalities such as time pressures, facilitator training, resident selection, and resource preparation. For residents, the groups provided a context for relating meaningfully to others.

CONCLUSION

The JAVA program achieved a high level of engagement. However, it was a time intensive intervention and required a person-centred philosophy, appropriate staff training, organisational support, and a suitable quiet space. The program had positive benefits, but practical issues identified needed to be considered before implementation.

Understanding the social and leisure needs of lonely and socially isolated older adults living in residential care: a qualitative study

Objectives: Rates of loneliness and social isolation increase following the transition to residential care and are associated with poor health outcomes. One way to mitigate these experiences is through meaningful recreation, however, there is research to suggest that currently available programming does not meet the needs of lonely and socially isolated residents. Therefore, the objectives of the current study were to investigate: (1) the lived experience of loneliness and social isolation in residential care, (2) engagement and use of available resources by these residents, and (3) insights as to how programming can further address their needs.Methods: Qualitative interviews were conducted with ten staff members and 14 residents. Interviews were transcribed and analysed using thematic analysis.Results: Three themes emerged from the data: (1) Feelings of loneliness and social isolation (subthemes: loneliness and social isolation differ, contributors, and coping strategies), (2) Recreation and social participation (subthemes: program engagement and barriers to participation), and (3) Supporting residents' needs (subthemes: suggestions for meaningful recreation and resources).Conclusion: Loneliness and social isolation are idiographic experiences. Contributors to loneliness and social isolation are also reported as barriers to attending programming. Recommendations are made, many of which rely on greater staffing resources and psychoeducation.

Tai Chi as a Body-Mind Exercise for Promotion of Healthy Aging in Nursing Home Residents: Appropriateness, Feasibility, and Effectiveness

The lack of activity, opportunity for providing input and participation in activities, and interaction with other people are the features of institutional living which reinforces dependency among nursing home residents. Residents are usually frustrated with paternalistic-type care. Arranging health-oriented meaningful activities for residents contributes to health promotion and enhancement of healthy aging. Moreover, it contributes to the cultivation of a positive meaning of life which is particularly important as residents reach the late geriatric stages of their lives. With exercise being seen as generally beneficial for health, Tai Chi as a Chinese-based exercise with a body-mind emphasis and unique characteristics becomes a particularly suitable exercise in aiding the residents in this major shift of lifestyle. This paper analyzes the appropriateness, feasibility, and effectiveness of Tai Chi in promoting healthy aging for residents. Theoretical considerations and scientific evaluations lend it appropriate, feasible, and effective in providing physiological and psychosocial health benefits to the residents. This paper recommends the use of Tai Chi to promote healthy aging in nursing home residents. With a rapidly aging population and mounting demand for residential geriatric care worldwide, this paper's timely findings should provide important implications for adopting Tai Chi to advance the quality of care delivered by nursing homes worldwide.

Exploring experiences of times without care and encounters in dementia: protocol for a living and adaptive evidence map

INTRODUCTION

Individuals with dementia spend most of the day without care, without encounters, and usually without activity. Although this has been proven in studies, there is a knowledge gap on how individuals with dementia experience these periods of time. Such knowledge would be highly relevant for health professionals and relatives to develop adequate strategies for dealing with these periods of time. The FreiZeit study aims to reconstruct periods of time without care and encounters from the perspective of individuals with dementia and formal and informal carers. The specific objective of this review is to provide a continuously updated overview of the topical evidence that may be used to guide data synthesis and interpretation within the FreiZeit study.

METHODS AND ANALYSIS

We conduct a living evidence map, based on a comprehensive systematic literature search in MEDLINE/PubMed, CINAHL, PsycINFO/Ovid and Web of Science Core Collection, citation-based searches and web searches. We include studies on times without care and encounters of individuals with dementia from the perspective of individuals with dementia themselves and formal or informal caregivers of any observational study design that were conducted in the institutional and domestic long-term care setting and published as journal article in English, French or German language without any restriction of the publication year. One reviewer screens titles, abstracts and full texts and extracts data. Key characteristics and results of the included studies are charted in a tabular format. The searches will be run and continuously updated throughout the duration of the overarching FreiZeit study (every 6 months for 2 years from 2023 to 2025).

ETHICS AND DISSEMINATION

Ethics approval is not required for this evidence map. We disseminate our findings via journal articles and conference proceedings as well as other formats.

REGISTRATION DETAILS

This review protocol is uploaded on Open Science Framework (OSF; DOI 10.17605/OSF.IO/GDYZ9).

Practices countering resident-to-resident aggression and promoting wellness care for older adults in congregate residential facilities: results from a systematic review

Resident-to-resident aggression (RRA) is an important issue in congregate residential facilities (CRFs) for older adults and has devastating effects. This study aimed to provide an inventory and content analysis of the practices used to counter RRA and promote wellness care for older adults in CRFs. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, original, peer-reviewed research and systematic reviews published in 14 electronic databases and two gray literature sources were examined. Of the 6196 articles identified, 28 met the inclusion criteria. Practices aimed to prevent, track or intervene in RRA, mostly in long-term care centers, but few were evidence-based and ready for widespread implementation. It emerges that continuous training of staff is necessary and that it should prioritize a person-centered approach. CRFs' managers must promote a culture of wellness care and policymakers should consider the prevention practices to improve the quality of life of older adults in CRFs.

Exploring nursing home resident and their care partner priorities for care using the Action-Project Method

BACKGROUND

Nursing home (NH) residents' experiences are embedded within their relationships to others. Our objectives were to describe how residents and care partners (family or staff members) jointly construct, discuss, and act on care priorities.

METHODS

We used Action-Project Method, a qualitative method focused on action within social context. We recruited 15 residents and 12 care partners (5 family and 7 staff members) from 3 urban NHs in Alberta, Canada. Residents and care partners participated in a video-recorded conversation about their experiences in the NH, then individually reviewed the video-recording to add context to the conversation. Following transcription, preliminary narrative construction, and participant feedback, the research team conducted in-depth analysis to identify participant actions, goals, and projects, including those jointly shared by dyad members.

RESULTS

All participants' intentions could be broadly described as "making time in the NH as good as possible" and projects were grouped into five categories: resident identity, relationships (both presence and absence), advocacy, positivity, and respectful care. Participants often raised issues of short-staffing as a significant barrier to respectful care. Care partners, especially staff, used positivity to redirect residents from difficult topics. Joint projects could be identified in some, but not all, cases.

CONCLUSIONS

We found that maintaining a sense of identity, fostering relationships, and receiving respectful care were important to residents but that short-staffing created barriers. Methods to capture these aspects of the resident experience are needed but should not be influenced by care partners' tendency towards positivity in resident interactions.

A conversational, small-story approach to narrative care for people with dementia living in care institutions: Strategies and challenges

The aim of the paper was to define what narrative care is and identify and discuss everyday conversational narrative care strategies regarding people living with dementia in long-term care institutional settings. To do so, we differentiate between two approaches to narrative care: a big-story approach (reflecting on life stories) and a small-story approach (enacting stories in everyday conservations). The paper is focused on the second approach, which appears to be particularly fit to be used with people living with dementia. We identify three main strategies to implement this approach in everyday care: (1) prompting and sustaining narratives; (2) valuing non-verbal and embodied cues; and (3) constructing narrative environments. Finally, we discuss some training, institutional and cultural barriers and challenges for providing conversational, small story-based narrative care for people living with dementia in long-term care institutions.

Organizational Innovation in Long Term Care Enabled by Collaboration Between Government Agencies: A Critical Realist Case Study

Long term care for older people is a highly regulated sector providing accommodation, health, and social care to vulnerable older adults. Older adults in New Zealand are among the highest users of long term care services globally. Traditionally those requiring specialist care for dementia are housed apart from other residents. In an example of organizational innovation, 1 provider relocated residents to a secure village where residents requiring specialist dementia care would be desegregated. We utilized a critical realist case study to explain the role of intersectoral collaboration among government agencies in supporting the transition while managing risk and ensuring regulatory compliance.

Experience of a demand-side subsidy scheme for residential long-term care: perspectives of elderly and their carers

BACKGROUND

Vouchers, which are demand-side subsidies to targeted groups, are a type of consumer-led near-cash social transfer for specified benefits that have been used in education, health and other sectors. To provide better access to residential care services and an additional choice for elderly people in need, a novel means-tested residential care service voucher has been introduced in Hong Kong for elderly people to purchase places in the private sector to enable consumer-directed care. The objectives of this paper are to analyze the perspectives of voucher users and their carers toward the voucher scheme and to identify key elements in the design that will contribute to meeting the scheme's objectives.

METHODS

An exploratory sequential mixed method design was adopted with initial explorative qualitative data collection of the perspectives of elderly people and their carers (Phase 1), which informed the design of the subsequent questionnaire survey (Phase 2). Thirty carers in 5 focus groups and 20 individual interviews with elderly people were conducted between April and May 2018. A total of 401 respondents (373 carers and 28 elderly people) completed the survey questionnaire. Findings from both phases were integrated both narratively and via a joint display.

RESULTS

Five key themes summarized the features in two main elements of the design and implementation of the voucher scheme: awareness, meaning that inadequate knowledge and understanding of voucher schemes hinder participation; service needs and types, indicating that the urgent need for residential care services is the key reason for participation; shared responsibility, meaning that a high copayment level discourages participation; choice and flexibility, reflecting appreciation of the additional choices provided by voucher schemes although the availability of residential care beds limits choices; and service quality, indicating mixed perceptions of service quality and the impact of the voucher scheme. Voucher users believe that the voucher scheme is more helpful for relieving the financial burden (98.7%), reducing carers' stress (97.0%) and reducing the waiting time for subsidized homes for elderly people (89.0%) than for increasing choice and flexibility (78.1%) and improving service quality (62.1%).

CONCLUSIONS

This study demonstrates how the design of a voucher scheme affects its take-up by targeted beneficiaries. When a voucher scheme is implemented in a long-term care system, it must consider the congruence with existing policies in long-term care provision and financing. The voucher scheme in Hong Kong has been able to generate the utilization of nonsubsidized places in homes for elderly people that were underutilized, but its effectiveness is limited by inadequate knowledge and understanding of the voucher scheme and the availability of residential care places. Giving the purchasing power and choice of providers to beneficiaries has the potential to enhance the quality of services, which will contribute to meeting the objectives. The study findings carry significant implications for long-term care policies and provide insights into the key features of the voucher scheme for residential care services and how to best design and implement a voucher scheme for elderly people in the context of policy objectives and a long-term care policy.

Exploring the factors influencing meaningful engagement of persons living with advanced dementia through the Namaste Care Program: a qualitative descriptive study

Background:

Meaningful engagement has been described as active participation based on a person’s interests, preferences, personhood, or perceived value. It has many benefits for persons living with dementia in long-term care (LTC) homes, including improvement in physical and cognitive function, and mental health. People with advanced dementia continue to need and benefit from inclusion and social contact in LTC, yet there is not a well-developed understanding of how to support this. A tailored intervention called Namaste Care has been shown to be an effective approach to meaningfully engage residents in LTC, decrease behavioral symptoms, and improve their comfort and quality of life. There is a need to consider how best to deliver this intervention.

Objective:

The aim of this study was to describe environmental, social, and sensory factors influencing meaningful engagement of persons with advanced dementia during Namaste Care implementation in LTC.

Methods:

In this qualitative descriptive study, focus groups and interviews were conducted with families, volunteers, staff, and managers at two LTC homes. Directed content analysis was conducted. The Comprehensive Process Model of Engagement was used as a coding framework.

Results:

With respect to environmental attributes, participants emphasized that a designated quiet space and a small group format were helpful for engagement. In terms of social attributes, participants emphasized Namaste Care staff capacity to deliver individualized care. Regarding sensorial factors, familiarity with the activities delivered in the program was emphasized.

Conclusion:

Findings reveal the need to offer small group programs that include adapted recreational and stimulating activities, such as Namaste Care, for residents at the end of life in LTC. Such programs facilitate meaningful engagement for persons with dementia as they focus on individual preferences, comfort, and inclusion while recognizing changing needs and abilities of residents.

Palliative Care, Intimacy, and Sexual Expression in the Older Adult Residential Care Context: "Living until You Don't"

Commonly, frail older adults move to residential care, a liminal space that is their home, sometimes a place of death, and a workplace. Residential facilities typically espouse person-centred values, which are variably interpreted. A critical approach to person-centred care that focuses on social citizenship begins to address issues endemic in diminishing opportunities for intimacy in the end-of-life residential context: risk-averse policies; limited education; ageism; and environments designed for staff convenience. A person-centred approach to residents' expressions of intimacy and sexuality can be supported throughout end-of-life care. The present study utilised a constructionist methodology to investigate meanings associated with intimacy in the palliative and end-of-life care context. There were 77 participants, including residents, family members and staff, from 35 residential facilities. Analysis identified four key themes: care home ethos and intimacy; everyday touch as intimacy; ephemeral intimacy; and intimacy mediated by the built environment. Residents' expressions of intimacy and sexuality are supported in facilities where clinical leaders provide a role-model for a commitment to social citizenship. Ageism, restrictive policies, care-rationing, functional care, and environmental hindrances contribute to limited intimacy and social death. Clinical leaders have a pivotal role in ensuring person-centred care through policies and practice that support residents' intimate reciprocity.

Peer support for people living with rare or young onset dementia: An integrative review

Objectives

The aim of this integrative review was to identify and synthesize the literature on peer support interventions for people living with or caring for someone with a rare or young onset dementia.

Design

A literature search of articles was performed using the Nipissing University Primo search system, a central index that enables simultaneous searches across databases which included MEDLINE (PubMed), Web of Science, PsycINFO, CINAHL, Sociological Abstracts, Cochrane Library.

Results

The eleven papers that met the inclusion criteria spanned eighteen years and from five countries. Studies reported on peer support programs that were either hospital-based (n = 6) or community-based (n = 4), and were predominantly led by disciplines in the health sciences. Only one study did not involve delivering services. There was a range of methodological quality within the studies included in the review. Further analysis and synthesis led to the identification of three overarching peer support themes. These included: (1) peers as necessarily part of social support interventions; (2) a theoretical portmanteau; and (3) dementia spaces and relationality.

Conclusion

Consistent with a much larger body of work examining peer involvement in social interventions, this review reinforced the valuable contribution of peers. A full understanding of the mechanisms of change was not achieved. Notwithstanding, the issue of studies neglecting to sufficiently conceptualize and describe interventions is an important one – drawing attention to the need to continue to explore varied delivery, including co-produced models, and more effective evaluation strategies to inform the dementia care sector.

"It Makes You Feel Good to Help!": An Exploratory Study of the Experience of Peer Mentoring in Long-Term Care

Social isolation and loneliness in long-term care settings are a growing concern. Drawing on concepts of social citizenship, we developed a peer mentoring program in which resident mentors and volunteers formed a team, met weekly for training, and paired up to visit isolated residents. In this article, we explore the experiences of the resident mentors. As part of a larger mixed-methods study conducted in 10 sites in Canada, we interviewed mentors (n = 48) and analysed data using inductive thematic analysis. We identified three inter-related themes: Helping others, helping ourselves described the personal benefits experienced through adopting a helping role; Building a bigger social world encapsulated new connections with those visited, and; Facing challenges, learning together described how mentors dealt with challenges as a team. Our findings suggest that a structured approach to mentoring benefits residents and helps them feel confident taking on a role supporting their isolated peers.

Promising best practices implemented in long-term care homes during COVID-19 pandemic to address social isolation and loneliness: a scoping review protocol

INTRODUCTION

Prior to the COVID-19 pandemic, social isolation and loneliness (SIL) affected at least one-third of the older people. The pandemic has prompted governments around the world to implement some extreme measures such as banning public gatherings, imposing social distancing, mobility restrictions and quarantine to control the spread and impact of the novel coronavirus. Though these unprecedented measures may be crucial from a public health perspective, they also have the potential to further exacerbate the problems of SIL among residents in long-term care homes (LTCHs). However, some LTCHs have developed promising best practices (PBPs) to respond to the current situation and prepare for future pandemics. Key aspects of such practices revolve around maintaining and strengthening social connections between residents and their families which helps to reduce SIL. This scoping review looks at existing PBPs that have been implemented to reduce SIL among LTCH residents during the most recent pandemics.

METHODS AND ANALYSIS

We will follow Arksey and O'Malley's framework of scoping review, further developed by Levac et al. In addition, we will also apply the Joanna Briggs Institute Reviewers' 'Methodology for Scoping Reviews'. Ten electronic databases and grey literature will be searched for articles published from January 2003 to March 2021 in either English or French. Two reviewers will independently screen titles and abstracts and then full texts for final inclusion. Data will be extracted using a standardised form from 'Evidence for Policy and Practice Information'. The results will be presented in a tabular form and will be summarised and interpreted using a narrative synthesis.

ETHICS AND DISSEMINATION

Formal ethical approval is not required as no primary data are collected. Findings will be used to develop a solid knowledge corpus to address the challenges of SIL in LTCHs. Our findings will help to identify cutting edge practices, including technological interventions that could support health services in addressing SIL in the context of LTCHs and our ageing society.

A systematic review of language and communication intervention research delivered in groups to older adults living in care homes

BACKGROUND

The communication skills of older adults living in care homes is an underexplored topic. Ageing can lead to reduced communication ability and activity; and in the care home environment there may also be fewer communication opportunities. This situation is likely to negatively impact well-being. Previous reviews have found evidence of the effectiveness of behavioural interventions in increasing well-being, but no systematic review to date has focused specifically on the evidence base for group language and communication interventions in this population.

AIMS

To identify and evaluate the evidence for behavioural interventions with older adults, delivered in groups in care homes, that specifically included a language or communication activity. To explore the impact of such intervention on the specific domains of language, communication and social interaction. To determine whether behavioural mechanisms of action can be identified.

METHODS & PROCEDURES

Embase, Medline, Ovid Nursing database, Psych info and CINAHL complete were searched and produced 158 records for screening, of which 22 remained for review. In order to identify and evaluate the quality of the evidence base presented the following research questions were posed: What research has been conducted in this area? What is the methodological quality of the studies identified? How complete is the intervention reporting? How was change measured in the domains of language, communication and social interaction? Is there evidence of efficacy, indicated by statistically significant improvement, in these domains? How did the interventions work? Synthesis tools employed included the PEDro-P Scale, the TIDieR checklist and the ITAX.

MAIN CONTRIBUTION

A total of 22 studies met the criteria for review. One study used solely language or communication interventions, but the remaining 21 studies used behavioural interventions which incorporated language and communication activities to varying degrees. Studies fell into four broad intervention types: reminiscence or life review; cognitive stimulation; narrative or storytelling; and multi-modality group communication. The majority of studies were of fair methodological quality, with a moderate level of detail provided in treatment reporting. Statistically significant improvement was reported by authors in all four intervention types and across language, communication and social domains. Social interaction, social support and behavioural skills were the most consistent mechanisms of action in the reviewed behavioural interventions.

CONCLUSIONS & IMPLICATIONS

Despite limitations in the evidence base, there are important positive signs for the beneficial effects of supporting language and communication in care homes. Blinding of assessors, and the accuracy and accessibility of statistical reporting are important areas to address in order to improve the quality of the evidence base.

WHAT THIS PAPER ADDS

Ageing can lead to reduced communication ability and activity, and in the care home setting there may also be fewer communication opportunities. This situation is likely to negatively impact well-being. Previous reviews have found evidence of the effectiveness of behavioural interventions in increasing well-being. The communication skills of older adults living in care homes is an underexplored topic. No systematic review to date has focused specifically on the evidence base for group language and communication interventions in this population. This review reveals important positive signs for the beneficial effects of supporting language and communication in care homes. Social interaction, social support, and behavioural skills were the most consistent mechanisms of action in the reviewed behavioural interventions.

'It makes life worthwhile!' Peer mentoring in long-term care-a feasibility study

Objectives: Loneliness and depression are of increasing concern in long-term care homes made more urgent by viral outbreak isolation protocols. An innovative program called Java Mentorship was developed that engaged community volunteers and resident volunteers (mentors) as a team. The team met weekly, received education, and provided visits and guidance in pairs to socially disengaged residents (mentees). The purpose of this study was to assess the feasibility of conducting a larger study.Method: We conducted a mixed-methods pre-post study to evaluate the program. We collected feasibility data associated with the program implementation, including assessment of the sample and ability to recruit; procedures for data collection; retention, program adherence and acceptability; and residents' responses including loneliness, depression, purpose in life, social identity and sense of belonging outcomes. We enrolled community mentors (n = 65), resident mentors (n = 48) staff facilitators (n = 24) and mentees (n = 74) in 10 Canadian sites.Results: Most feasibility objectives were met, and adherence and acceptability were high. Some resource challenges and low retention rates among resident mentors were noted. We found a 29% reduction in depression scores (p = .048; d = .30) and 15% reduction in loneliness scores (p = .014; d = .23). Purpose in life, social identity and sense of belonging were unchanged. Interviews among participants indicated high acceptability and positive perceptions of the program.Conclusion: The study findings reveal a potential role for mentorship as a viable approach to reducing loneliness and depression in long-term care settings and lay the groundwork for future research.

Assessing Social Functioning During COVID-19 and Beyond: Tools and Considerations for Nursing Home Staff

Social functioning is defined as how a person operates in their unique social environment (ie, engagement in activities, connectedness with others, and contributions to social roles). Healthy social functioning is important for nursing home residents as they are at increased risk for loneliness and isolation. Social functioning has long been an underacknowledged aspect of nursing home residents' health, but now, with the COVID-19 pandemic, residents' risk for decreased social functioning is increased. Several reliable and well-validated tools are available to supplement routine care planning and delivery and track and improve changes in social functioning over time. The overarching aim of this article is to provide resources and recommendations for interdisciplinary team assessment related to social functioning for nursing home residents. We describe 2 domains of social functioning measures, care-planning measures and outcome measures, and provide recommendations for how to integrate said measures into practice. Healthy social functioning is needed to maintain nursing home residents' well-being and quality of life. Measures and recommendations outlined in this article can be used by nursing home staff to understand residents' social preferences and address social functioning during COVID-19 and beyond.

A pilot study implementing the JAVA Music Club in residential care: impact on cognition and psychosocial health

BACKGROUND

Ninety percent of long-term care (LTC) residents experience some form of cognitive impairment. Social support may benefit cognition by decreasing depressive symptoms and loneliness, which are commonly reported among LTC residents.

OBJECTIVE

To investigate the effects of the Java Music Club (JMC), a manualized social support program, on cognition and psychosocial health among LTC residents using a pre-post mixed-methods approach.

METHODS

The JMC was implemented once a week for twelve weeks. Participants (n = 24, 91.7% female) completed cognitive tasks and psychosocial questionnaires before (T1), after (T2), and twelve weeks following (T3) participation in the JMC. Qualitative interviews were conducted at T2 with participants and recreation coordinators.

RESULTS

Analyses showed decreased loneliness from T1 to T2 (t = 3.31, p = .003) and reductions in depressive symptoms (F = 3.459, p = .043) and subjective memory complaints (F = 3.837, p = .048) from T2 to T3. Participants' qualitative interviews (N = 19) illustrate that the JMC was a positive experience that promoted social engagement. Important group elements included the group facilitator and group composition. Possible process elements included social engagement, the opportunity for reminiscence, and the ability of both social interaction and singing to benefit the residents and lift their 'spirits'. Recreation coordinators (N = 3) reported that the group was unlike currently available group programs and increased socialization between residents.

CONCLUSIONS

Participation in the JMC may be a promising approach to counter loneliness, depressive symptoms and subjective memory complaints in LTC 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.

Co-Development of a Web-Based Hub (eSocial-hub) to Combat Social Isolation and Loneliness in Francophone and Anglophone Older People in the Linguistic Minority Context (Quebec, Manitoba, and New Brunswick): Protocol for a Mixed Methods Interventional Study

BACKGROUND

The first wave of the COVID-19 pandemic has severely hit Canadian nursing facilities (81% of deaths). To this toll, public health measures (eg, visitation restriction) have subsequently deepened the social isolation and loneliness of residents in nursing facilities (NFs), especially those in linguistic minority settings: Anglophone institutions in Quebec and Francophone institutions outside Quebec. However, very few COVID-19 initiatives targeting these populations specifically have been documented. Given the limited number of NFs serving linguistic minorities in Canadian populations, families and loved ones often live far from these facilities, sometimes even in other provinces. This context places the digital solutions as particularly relevant for the present COVID-19 pandemic as well as in the post-COVID-19 era.

OBJECTIVE

This project aims to co-develop a virtual community of practice through a web-based platform (eSocial-hub) to combat social isolation and loneliness among the older people in linguistic minority settings in Canada.

METHODS

An interventional study using a sequential mixed methods design will be conducted. Four purposely selected NFs will be included, 2 among facilities in Manitoba and 2 in New Brunswick; and 2 Anglophone NFs in Quebec will serve as knowledge users. The development of eSocial-hub will include an experimental 4-month phase involving the following end users: (1) older people (n=3 per NF), (2) families of the participating older people (n=3 per NF), and (3) frontline staff (nurse and health care aid; n=2 per NF).

RESULTS

Activities and solutions aiming at reducing social isolation and loneliness will be implemented and then evaluated with the project stakeholders, and the best practices generated. The assessment will be conducted using indicators derived from the 5 domains of the Consolidated Framework for Implementation Research. The project will be led by an interdisciplinary team and will involve a multisectoral partnership.

CONCLUSIONS

The project will develop a promising and generalizable solution that uses virtual technology to help reduce social isolation and loneliness among the older people.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/30802.

Social Isolation in Dementia: The Effects of COVID-19

The aim of this literature review is to identify the effects of social isolation and lonliness on persons with dementia and to highlight interventions for private homes and long-term care facilities. It includes articles published in the last 5 years for a total of 45 articles. Social isolation and/or lonliness is linked to reduced quality of life, neuropsychiatric symptoms, and psychotropic drug use in people living with demential. Interventions, including physical activity, should be individualized and patient centered.

Feasibility and Effectiveness of a Biography-Based Physical Activity Intervention in Institutionalized People With Dementia: Quantitative and Qualitative Results From a Randomized Controlled Trial

The objective of this multicenter randomized controlled trial was to evaluate the feasibility and effectiveness of a physical activity intervention for institutionalized people with dementia, individualized by capacity and biography. The intervention group (n = 34; age: mean = 86.09 years; 79.40% female; mean Mini-Mental State Examination value = 18.59) participated in a multicomponent training program, which included daily activities, dancing, gardening, and sports/games, twice weekly for 3 months. The control group (n = 29; age: mean = 86.34 years; 75.90% female; mean Mini-Mental State Examination value = 19.90) received standard care. Feasibility was evaluated by means of focus groups and feedback questionnaires. Functional performance (Short Physical Performance Battery and Timed Up and Go Test), activities of daily living, and gait were outcomes for effectiveness. A high adherence rate (80.46%) and uniformly positive feedback indicate that the piloted training program is feasible. The results show preliminary effectiveness on functional performance (Short Physical Performance Battery mean t0 = 3.15; mean t1 = 4.50; p = .006) and gait (e.g., velocity mean t0 = 46.97; mean t1 = 58.04; p = .007).

Assisted Living Residents with Dementia: Being Out in the World and Negotiating Connections

BACKGROUND AND OBJECTIVES

Persons living with dementia, including long-term care residents, and their care partners emphasize the importance of meaningful engagement and stress the need for activity and opportunities to go outdoors or offsite. Yet, little is known about getting out in this population. Here, our objectives are to: 1) identify residents' opportunities for, and experiences with, getting out; 2) understand the significance of getting out; and 3) explain influential factors.

RESEARCH DESIGN AND METHODS

Guided by grounded theory methods, we analyzed qualitative data collected over a one-year period in four diverse assisted living communities. We followed 33 residents with dementia and their care partners. Data include detailed fieldnotes capturing 1,560 observation hours, 114 interviews with residents (where possible), assisted living staff, family members, and other visitors, and record review.

RESULTS

We identified the centrality of "being out in the world and negotiating connections," which characterizes residents' experiences with the outside world as a process of 'working out' engagement with nature, others, and the community. Being out in the world was consequential to well-being and quality of life. Most residents got out at least occasionally; some lacked opportunities. Among residents who got out, most benefitted from ensuing connections. Yet, not all experiences were positive. Being out in the world varied over time and by individual-, convoy-, AL community-, and neighborhood-level factors.

DISCUSSION AND IMPLICATIONS

We discuss the implications of our findings for research and practice surrounding meaningful engagement among persons with dementia, including during crises such as the pandemic.

Impact of an artist-in-residence program in a complex continuing care hospital: a quality improvement investigation

Background: The objective was to assess the impact of an Artist-in-Residence (AiR) program on the quality of life of patients living at a complex continuing care hospital.Methods: In the AiR program, a professional Artist facilitated the creation of community art projects by patients in groups (before COVID-19) and individually (during COVID-19). Four patients, four staff and one family member involved with the program were interviewed to assess their experiences.Results: Themes identified included improvements in spiritual, mental and community health, creation of a sense of community, learning skills and knowledge surrounding art and culture, and the importance of the Artist's personal characteristics/personality. It was recommended to continue and expand the program.Conclusions: The patients deeply enjoyed the AiR program and working with the Artist. Non-patient participants also recognized benefits for the hospital community. Procurement of stable funding and expansion of the program are areas to focus on next.

The experience of loneliness and living with sight loss in English care homes

Loneliness is a serious societal concern, especially the loss of social connections in later life. Those with sight loss living in care homes are thought to face particular challenges in social engagement, but research is scarce. This study aimed to examine the experience of loneliness amongst residents with sight loss; the different dimensions of loneliness; and their attitudes about the role of care homes in addressing these needs. Through in-depth interviews with 18 residents, supplemented by interviews with family members and care home managers, the research identified that residents were generally satisfied with their social situation. However, there was evidence that sight loss was not appropriately accommodated within the care home. In their efforts to enable all residents to engage in social activities, attempts to include those with sight loss could feel contrived, and residents with sight loss did not feel meaningfully involved. Residents described barriers to forming close associations, including the challenges of background noise in communal spaces and a sense that conversation in the care home lacked stimulation. Residents felt that opportunities to forge and maintain bonds with people outside the care home were limited. The research concludes that care homes should avoid inclusion-for-inclusion's sake, and future research could study the effectiveness of interventions to improve care home links to the wider community.

Needs of older persons living in long-term care institutions: on the usefulness of cluster approach

Background

Long-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care.

Methods

The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis.

Results

Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters.

Conclusions

Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.

Meaningful Engagement Among Assisted Living Residents With Dementia: Successful Approaches

Meaningful engagement is an important dimension of quality of life and care for persons living with dementia, including the growing number who reside in assisted living communities. This report presents preliminary findings from an ongoing qualitative study aimed at identifying best care practices to create and maintain meaningful engagement among persons with dementia. Over a 1-year period, we conducted interviews, residents' record review, and participant observations in four diverse care communities. Our analysis identified four approaches that successfully promote meaningful engagement: (a) knowing the person, (b) connecting with and meeting people where they are, (c) being in the moment, and (d) viewing all encounters as opportunity. Incorporation of these approaches in care routines and adoption by all care partners can promote meaningful engagement, including during crises such as COVID-19.

Iatrogenic loneliness and loss of intimacy in residential care

BACKGROUND

There is an international trend for frail older adults to move to residential care homes, rather than ageing at home. Residential facilities typically espouse a person-centred philosophy, yet evidence points to restrictive policies and surveillance resulting in increased loneliness and diminished opportunities for intimacy and sexual expression. Residents may experience what has been termed social death, rather than perceive they are related to by others as socially alive.

AIM

To consider how the loss of intimacy and sexuality in residents' lives contributes to iatrogenic loneliness experienced in residential care, and the importance of considering these issues together.

RESEARCH DESIGN

The study utilised a constructionist methodology, investigating the meanings associated with intimacy, loneliness, and ageing.

PARTICIPANTS AND RESEARCH CONTEXT

Qualitative data used in this study are drawn from a larger dataset of a mixed-methods study. Interviews were completed as follows: staff, 21 individual interviews, and two groups with a total of 13 additional people; residents, 26 interviews with 28 people; and family members, 12 interviews with 13 people.

FINDINGS

Five key themes were identified in the data analysis: loneliness and relational identity, loneliness and functional relationships, loneliness and disrupted intimacy, loneliness and liminality, and loneliness and the built environment.

ETHICAL CONSIDERATIONS

The study was approved by a University Human Ethics Committee. Participation was voluntary. Consent was gained and confidentiality upheld.

DISCUSSION

Residents' expression of intimacy and sexuality can be compromised through paternalism, ageism, restrictive policies, care-rationing and functional care, alienating residents from sustaining and developing significant relationships. Attitudes and cultural beliefs of staff and family members about ageing and intimacy, compounded by architectural design, may intensify loneliness.

CONCLUSIONS

Nurses have a pivotal role in ensuring policies and practice enhance social citizenship.

Feasibility of school students Skyping care home residents to reduce loneliness

Background

Intergenerational friendship has proved useful for older people in increasing socialisation. We explored the feasibility of school students Skyping older people in care homes with the long-term aim of reducing loneliness.

Methods

Six school students from one secondary school and twenty older people, including seven with mild to moderate dementia, from three care homes, engaged in Skype video-calls over six weeks. A conversational aid aimed to help school students maintain conversations was employed. Students and care staff completed feedback forms after each session on video-call usage, usefulness of the conversational aid, and barriers and benefits of video-calls. Six care staff provided further feedback on residents’ experiences through unstructured interviews. Interviews and field notes were thematically analysed.

Results

Residents enjoyed Skype-calls with school students. Over six weeks, video-calls became longer, and more residents participated. Analysis revealed four themes. First, the intervention led to increased mobility for three older people and improved self-care in regard to personal appearance for five residents. Second, school students and older people formed friendships which inspired the need to meet in person. Third, the use of video-calls enabled participants to view each other’s environments in real time. Last, directly experiencing the intervention was important for the continued participation of the care staff in the study. Skype-calls between schools and care homes are feasible and may help reduce loneliness.

Conclusions

Institutional collaboration between educational settings and care homes through cost effective video-calls can be useful to increase socialisation for older people, and promote later on-going use with other external organisations to help reduce loneliness and social isolation.

•

Older people in care including those with dementia are capable of forming new non-familial social relationships using video-calls.

•

Regular video-calls for older people increases mobility, self-care and socialisation.

•

Intergenerational video-calls between care homes and schools are feasible to reduce loneliness in older adults.

•

A conversational aid is useful in aiding conversations to form new friendships.

How Elderly Residents in Nursing Homes Handle Loneliness-From the Nurses' Perspective

Introduction

Elderly people who leave their home environment and move to a nursing home enter a phase in life with diminishing contact with family and friends. This situation often results in a feeling of loneliness with a concomitant deterioration in physical and mental health. By exploring the topic through the lens of the nurses, this study takes a novel approach to address an under-researched area in the nursing field.

Objective

The objective of the study was to identify, based on the nurses’ experience, how elderly residents handle loneliness in the nursing home.

Methods

This study used a qualitative explorative approach with data collected through two focus group interviews with nine nurses at two elderly care facilities in Norway. The resulting transcripts were examined using an approach based on inductive content analysis.

Results

Three main categories emerged as crucial to help lonely nursing home residents cope with day-to-day life: (i) maintaining ties to one’s earlier life; (ii) engaging in recreational pursuits; and (iii) building new networks.

Conclusion

Analysing the findings based on sense of coherence (SOC) and person-centred care (PCC) theories illustrates the importance of maintaining a connection with both family and friends. To that point, having access to familiar objects from their earlier life seemingly provides meaning to the residents by bridging the past and the present. Recreational activities, ideally adapted to each person’s needs and ability, have a positive impact by providing structure and meaning that help overtake feelings of loneliness. Building a new network with fellow residents and staff imparts a sense of meaningful community belonging and projects both dignity and self-worth.

Characteristics of Socially Isolated Residents in Long-Term Care: A Retrospective Cohort Study

Objectives: To identify socially isolated long-term care residents and to compare their demographic characteristics, functional status, and health conditions to residents who are not isolated. Methods: We conducted a retrospective cohort study using the Resident Assessment Instrument, Minimum Data Set, 2.0 (RAI-MDS) data, from residents in 34 long-term care homes in Alberta, Canada (2008–2018). Using logistic regression, we compared the characteristics, conditions, and functional status of residents who were socially isolated (no contact with family/friends) and non-socially isolated residents. Results: Socially isolated residents were male, younger, and had a longer length of stay in the home, than non-socially isolated residents. Socially isolated residents lacked social engagement and exhibited signs of depression. Discussion: Socially isolated residents had unique care concerns, including psychiatric disorders, and co-morbid conditions. Our approach, using a single item in an existing data source, has the potential to assist clinicians in screening for socially isolated long-term care residents.

Nursing home residents' ADL status, institution-dwelling and association with outdoor activity: a cross-sectional study

Introduction

The Norwegian regulations for nursing homes consider access to meaningful activities to be an indicator for the quality of nursing homes. Activities of daily living (ADL) provide important basic self-care skills for nursing home residents. Due to the physical changes caused by ageing and comorbidities, nursing home residents may experience functional decline over time, which may affect their ability to perform meaningful ADL, such as outdoor activity, which is considered a valuable and meaningful activity in Norwegian culture. This study aimed to investigate the association between ADL status, institution-dwelling and outdoor activity among nursing home residents.

Methods

This cross-sectional study included 784 residents aged >67 years living in 21 nursing homes in 15 Norwegian municipalities between November 2016 and May 2018. The Barthel Index was used to assess the nursing home residents' ADL status. Other variables collected were age, gender, body weight and height, visits per month, institution, ward, and participation in weekly outdoor activities. Descriptive statistics were used to provide an overview of the residents' characteristics. A Poisson regression model was used to test the association between the outdoor activity level as the dependent variable and ADL score, institution, and other control variables as independent variables.

Results

More than half (57%) of the nursing home residents in this sample did not go outdoors. More than 50% of the residents had an ADL score <10, which indicates low performance status. Further, we found that residents' ADL status, institution, ward, and number of visits had an impact on how often the residents went outdoors.

Discussion

The nursing home residents in this study rarely went outdoors, which is interesting because Norwegians appreciate this activity. Differences in the number of visits might explain why some residents went outdoors more often than other residents did. Our findings also highlight that the institutions impact the outdoor activity. How the institutions are organized and how important this activity is considered to be in the institutions determine how often the activity is performed.

Conclusion

The low frequency of the outdoor activities might be explained by a low ADL score. More than 50% of the residents had an ADL score <10, which indicates low performance status. Despite regulations for nursing home quality in Norway, this result suggests that organizational differences matter, which is an important implication for further research, health policy and practice.

Challenges in Caring for Unbefriended Residents in Long-term Care Homes: A Qualitative Study

OBJECTIVES

This study examined challenges experienced by long-term care staff in caring for unbefriended residents who are incapacitated and alone. These residents often are estranged from or have no living family or live geographically distant from them and require a public guardian as their surrogate decision-maker. To date, research on unbefriended older adults has focused on those living in acute care and community settings. Little is known about those living in long-term care homes.

METHOD

We conducted semi-structured interviews with 39 long-term care staff (e.g., registered nurses, care aides, social workers) and 3 public guardians. Staff were sampled from seven long-term care homes in Alberta, Canada. We analyzed interview transcripts using content analysis and then using the theoretical framework of complex adaptive systems.

RESULTS

Long-term care staff experience challenges unique to unbefriended residents. Guardians' responsibilities did not fulfill unbefriended residents' needs, such as shopping for personal items or accompanying residents to appointments. Consequently, the guardians rely on long-term care staff, particularly care aides, to provide increased levels of care and support. These additional responsibilities, and organizational messages dissuading staff from providing preferential care, diminish quality of work life for staff.

DISCUSSION

Long-term care homes are complex adaptive systems. Within these systems, we found organizational barriers for long-term care staff providing care to unbefriended residents. These barriers may be modifiable and could improve the quality of care for unbefriended residents and quality of life of staff. Implications for practice include adjusting public guardian scope of work, improving team communication, and compensating staff for additional care.

Social Participation in Long-term Residential Care: Case Studies from Canada, Norway, and Germany

Meaningful social engagement in everyday activities can enhance resident quality of life in nursing homes. In this article, we draw on data collected in a multidisciplinary, international study exploring promising practices in long-term care homes across Canada, Norway, and Germany, to investigate conditions that either allow for or create barriers to residents' social participation. Within a feminist political economy framework using a team-based rapid ethnography approach, observations and in-depth interviews were conducted with management, staff, volunteers, students, families, and residents. We argue that the conditions of work are the conditions of care. Such conditions as care home location, building layout, staffing levels, and work organization, as well as governing regulations, influence if and how residents can and do engage in meaningful everyday social life in/outside the nursing home. The presence of promising conditions that facilitate resident social participation, particularly those promoting flexibility and choice for residents, directly impacts their overall health and well-being.

Combating Heightened Social Isolation of Nursing Home Elders: The Telephone Outreach in the COVID-19 Outbreak Program

OBJECTIVE

Social isolation and loneliness-common concerns in older adults-are exacerbated by the COVID-19 pandemic. To address social isolation in nursing home residents, the Yale School of Medicine Geriatrics Student Interest Group initiated a Telephone Outreach in the COVID-19 Outbreak (TOCO) Program that implements weekly phone calls with student volunteers.

METHODS

Local nursing homes were contacted; recreation directors identified appropriate and interested elderly residents. Student volunteers were paired with elderly residents and provided phone call instructions.

RESULTS

Three nursing homes opted to participate in the program. Thirty elderly residents were paired with student volunteers. Initial reports from recreation directors and student volunteers were positive: elderly residents look forward to weekly phone calls and express gratitude for social connectedness.

CONCLUSIONS

The TOCO program achieved initial success and promotes the social wellbeing of nursing home residents. We hope to continue this program beyond the COVID-19 pandemic in order to address this persistent need in a notably vulnerable patient population.

Remembering the past, enhancing the present and sharing the future: a qualitative study of the impact of film screenings in care home communities

Many care home residents lack opportunities for meaningful activity and social connection, resulting in poor physical and emotional wellbeing. Providing residents with varied activities and social opportunities can improve their quality of life. In this paper, we examine the potential for film to provide a meaningful, social activity. The limited existing research on film in care homes has predominantly examined the use of film clips and materials in stimulating reminiscence for people with dementia. In this paper, we adopt a broader, trans-disciplinary perspective of film, drawing on evidence from Film Studies that shared spectatorship has social and emotional benefits for the viewer. We offer the first qualitative study of care home residents’ social, emotional and embodied engagement with feature-length film and identify the key benefits of film in this setting. We ran social film screenings in two Scottish care homes over six weeks. Underpinned by psycho-cinematic theory, we collected and analysed observational data alongside interviews with care home staff and discussion groups with residents. Our findings identified three ways in which film screenings benefit residents and supports social connection: prompting reminiscence; enhancing residents’ experiences in the present; and creating a shared future and intergenerational connections. The paper offers useful insights into the rich potential for film to enhance the care home community, facilitate social connectivity and promote resident wellbeing.

A Comparative Study of Perceived Social Support and Depression among Elderly Members of Senior Day Centers, Elderly Residents in Nursing Homes, and Elderly Living at Home

Background

Social support perceived by the elderly can reduce mental health problems including depression. In Iranian society, some elderly people spend their elderly years in senior day care centers established to promote social protection for the elderly. Therefore, the purpose of this study was to assess perceived social support and depression in the elderly members of senior day care centers and compare the results with that of elderly individuals living at nursing homes and at home.

Materials and Methods

This descriptive, cross-sectional study was conducted on 315 elderly people. The participants were selected using stratified random sampling method and a random number table. The data collection tools used consisted of a demographic characteristics questionnaire, the Barthel index for assessing Activities of Daily Living (ADL), Social Support Appraisals (SSS-As) scale, and Geriatric Depression Scale short form (GDS-15). ANOVA, Chi-square, the Pearson correlation coefficient, and linear regression analysis were used to examine the hypotheses.

Results

The results showed that with increasing social support, depression decreased in all three groups, which was statistically significant in the two elderly groups living in nursing homes (r = -0.19, p = 0.044) and elderly members of senior day centers (r = -0.18, p = 0.049).

Conclusions

According to the results, it can be concluded that senior day care centers have been able to promote perceived social support in the elderly through their participation in daily activities and social activities, and thus were able to reduce depression significantly compared to the other two groups.

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

OBJECTIVE

The objective of this scoping review is to chart the literature on assistive technologies that support social interaction (excluding robots) used with older adults in long-term care (LTC).

INTRODUCTION

The need for LTC in institutional settings is in high demand. Loneliness and social isolation are common in these settings. Technology holds potential to contribute to mitigation of loneliness. As there are no systematic reviews examining forms of assistive technologies to support social interaction other than robots, used within LTC settings, there is a need to categorize the current research regarding such technologies to inform practice, policy and any need for further research.

INCLUSION CRITERIA

The review will consider studies based in LTC institutional settings with participants (≥65 years), institutional staff and visiting family members METHODS:: The JBI methodology for scoping reviews will be employed. This includes a three-step search strategy: i) identify keywords from CINAHL and PsycINFO, ii) conduct a second search using all identified keywords across select databases, and iii) screen the reference lists of all included articles and reports for additional studies. Titles and abstracts will be screened by two independent reviewers. Full text of selected citations will be assessed against inclusion criteria by two independent reviewers. A data extraction tool will be used, and extracted data will be presented in a narrative accompanied by diagrams or tables that reflect the objective of the review.

Fostering older adult care experiences to maximize well-being outcomes

Purpose

Caring for older adults is an increasingly complex and multi-dimensional global concern. This article provides a comprehensive definition of the older adult care experience and discusses its key components to help practitioners deliver older adult-centered care to maximize well-being outcomes for older adults.

Design/methodology/approach

Based on prior research on service operations, service experience, person-centered care and the unique, evolving needs of older adults regarding their care, this paper develops a conceptual framework in which the older adult care experience is the central construct, and key dimensions of well-being are the outcomes.

Findings

The older adult care experience is shaped by older adults' perceptions and evaluations of the care that they receive. Older adult-centered care has autonomy, dignity, unique needs and social environment as its core dimensions and results in those older adults feel empowered, respected, engaged and connected as part of their experience. The article also discusses how such experience can be evaluated by using quality dimensions from service operations, hospitality and healthcare contexts, and challenges that service firms may face in creating older adult care experience.

Research limitations/implications

Given the changing demographics and unique needs of older adults, it is an imperative for academics and practitioners to have an understanding of what determines older adult care experience to better serve them. Such understanding is important as by creating and fostering older adult care experience, service organizations can contribute to individual and societal well-being.

Originality/value

To the authors' best knowledge, this is the first paper to provide a comprehensive conceptualization of the older adult care experience.

Social integration and loneliness among long-term care home residents: protocol for a scoping review

INTRODUCTION

Social well-being is associated with better physical and mental health. It is also important for quality of life, including from the perspectives of those living in long-term care (LTC) homes. However, given the characteristics of the LTC home environment and the people who live there, the nature and influence of social integration and loneliness, and strategies to address them, may differ in this population compared with those living in the community. The objective of this scoping review is to provide an overview of the nature and extent of research on social integration and loneliness among LTC home residents, including a summary of how these concepts have been operationalised and any evidence from specific groups.

METHODS AND ANALYSIS

This study protocol describes the methods of a scoping review of peer-reviewed literature related to social integration and loneliness among LTC home residents. A literature search was developed by an Information Specialist and will be conducted in MEDLINE(R) ALL (in Ovid, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily) and then translated into CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (Proquest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid) and AgeLine (EBSCO). Two reviewers will independently screen titles and abstracts of articles identified in the search. Two reviewers will then independently review full text articles for inclusion. Data extraction will also be carried out in duplicate. We will engage LTC home community members, including residents, family and staff, to refine the review questions, assist in interpreting the results and participate in knowledge translation.

ETHICS AND DISSEMINATION

Ethics approval is not required. We will present findings at conferences and publish in a peer-reviewed journal. Ultimately, we hope to inform future observational and interventional research aimed at improving the health and quality of life of LTC home residents.

Loneliness in assisted living facilities: An exploration of the group process

BACKGROUND

More than one in three older people in assisted living facilities suffer from loneliness that leads to adverse health outcomes. Group work may have the potential to improve residents' quality of life.

AIMS/OBJECTIVES

The purpose of this feasibility study was to thoroughly describe a facilitated group process and compare its effects on cognitively impaired (n = 6) and cognitively intact (n = 7) lonely resident groups in assisted living facilities.

MATERIAL AND METHODS

We used a closed, occupational therapy-oriented group model designed for lonely people. The study used a qualitative, multi-method approach. Material included individual and focus group interviews, observations and the facilitators' field diaries.

RESULTS

Loneliness was reflected in diverse ways in both groups. Meaningful activities in mutual interaction played an important role in empowering the participants and enabling the development of the group process. Group processes had similar, parallel steps, from which the participants seemed to benefit. Surprisingly, the cognitively impaired group progressed towards self-direction more quickly than the cognitively intact group.

CONCLUSIONS

A group process with clearly progressing steps revealed that lonely older people are capable of empowerment and self-direction - despite their frailty and cognitive impairment. Facilitators should be familiar with group processes to enable them to progress effectively.