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Collins JT, Irvine L, Logan P, Robinson K, Sims E, Gordon AL. Quality of life, pain and use of analgesic, anxiolytic and antidepressant medication, in people living in care homes. Age Ageing 2024; 53:afae196. [PMID: 39238123 PMCID: PMC11377180 DOI: 10.1093/ageing/afae196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/10/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND People living in care homes often have problems with pain, anxiety and depression. Whether being on analgesia, anxiolytics or antidepressants has any bearing on pain severity and quality of life (QoL) in this population, requires further investigation. OBJECTIVES (i) to examine the relationship between pain, anxiety and depression and medication use in care home residents and (ii) to compare those on medications to treat pain, anxiety and depression, and those who were not, and associations with pain severity and overall QoL. METHODS This was a secondary analysis of a randomised controlled trial testing a falls prevention intervention in care homes. We recorded pain, anxiety and depression, QoL measurements and prescribed medication use. RESULTS In 1589 participants, the mean age was 84.7 years (±9.3 SD), 32.2% were male and 67.3% had a diagnosis of dementia. 54.3% and 53.2% of participants had some level of pain and anxiety or depression respectively, regardless of prescribed medication use. There was a direct association between pain severity and being on any analgesia, opioid analgesia, and antidepressants, but no associations between pain severity and use of paracetamol and anxiolytics. QoL was best for residents with no pain and not on any analgesia, anxiolytics or antidepressants and worst for those with moderate-extreme pain and taking at least two of these classes of medications. CONCLUSION Many care home residents live with pain, anxiety and depression. Addressing residents' pain may also increase their quality of life, but using medication alone to reach this goal may be inadequate.
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Affiliation(s)
- Jemima T Collins
- Centre for Rehabilitation and Ageing, Injury, Recovery and Inflammation Sciences Academic Unit, School of Medicine, the University of Nottingham, Nottingham, UK
- University Hospitals Derby and Burton NHS Trust, Derby, UK
| | - Lisa Irvine
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Pip Logan
- Centre for Rehabilitation and Ageing, Injury, Recovery and Inflammation Sciences Academic Unit, School of Medicine, the University of Nottingham, Nottingham, UK
| | - Katie Robinson
- Centre for Rehabilitation and Ageing, Injury, Recovery and Inflammation Sciences Academic Unit, School of Medicine, the University of Nottingham, Nottingham, UK
- Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Erika Sims
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Adam L Gordon
- Centre for Rehabilitation and Ageing, Injury, Recovery and Inflammation Sciences Academic Unit, School of Medicine, the University of Nottingham, Nottingham, UK
- University Hospitals Derby and Burton NHS Trust, Derby, UK
- Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
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Norvilaitė A, Newland JA, Blaževičienė A. Older people's experience and related factors while receiving home-based long-term care services: a qualitative study. BMC Nurs 2024; 23:580. [PMID: 39169322 PMCID: PMC11340139 DOI: 10.1186/s12912-024-02234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Home-based care may cover anything from 24-hour support for people with a disability, to short-term post-discharge care, or to periodic assistance with simple tasks such as domestic aid for frail older people. The process can be complex and time-consuming and requires coordination between the individual, their family caregivers, and healthcare providers. Receiving care at home can also lead to social isolation as older people may have limited opportunities for social interaction. This study aimed to investigate older people's experience and related factors while receiving home-based long-term care services. METHODS A qualitative study was used. Face-to-face individual interviews were conducted with people who were receiving nursing care in their homes (N = 17) and analyzed through thematic analysis. RESULTS Analysis of interview data resulted in the identification of three major themes that captured participants' personal experiences regarding long-term care in the home: (1) Challenges faced by older people receiving long-term care at home; (2) The impact of home care services on people's social well-being; and (3) Older people's contradictory emotions regarding care delivery. CONCLUSIONS Findings of the study revealed that the most important and challenging factors in home care from the perspective of older people were social well-being, religious needs, and physical needs. They considered the nurses who provided these services as family members and the most significant helpers in their daily activities. Participants expressed a desire for more services in the future.
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Affiliation(s)
- Arūnė Norvilaitė
- Department of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Daari L, Finnegan HA, Jaiswal A, Sriranganathan A, Cameron CD, Haczkewicz KM, Monnin C, Aubrecht K, Bielska I, Cheng I, Conway A, Sinn CLJ, Ghandour EK, Gallant NL. Caregiving in long-term care before and during the COVID-19 pandemic: a scoping review. Eur Geriatr Med 2024:10.1007/s41999-024-01029-3. [PMID: 39103740 DOI: 10.1007/s41999-024-01029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE The COVID-19 pandemic magnified pre-existing socioeconomic, operational, and structural challenges in long-term care across the world. In Canada, the long-term care sector's dependence on caregivers as a supplement to care workers became apparent once restrictive visitation policies were employed. We conducted a scoping review to better understand the associations between caregiving and resident, formal and informal caregiver health in long-term care before and during the COVID-19 pandemic. METHODS A literature search was performed using MEDLINE, AgeLine, Google Advanced, ArXiv, PROSPERO, and OSF. Pairs of independent reviewers screened titles and abstracts followed by a review of full texts. Studies were included if they reported biological, psychological, or social health outcomes associated with caregiving (or lack thereof). RESULTS After screening and reviewing 252 records identified by the search strategy, a total of 20 full-text records were eligible and included in this review. According to our results, research on caregiving increased during the pandemic, and researchers noted restrictive visitation policies had an adverse impact on health outcomes for residents and formal and informal caregivers. In comparison, caregiving in long-term care prior to the pandemic, and once visitation policies became less restrictive, led to mostly beneficial health outcomes. CONCLUSION Caregiver interventions, for the most part, appear to promote better health outcomes for long-term care residents and formal and informal caregivers. Suggestions to better support caregiving in long-term care settings are offered.
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Affiliation(s)
- Laura Daari
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Heather A Finnegan
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Atul Jaiswal
- Centre of Excellence, Perley Health, Ottawa, Canada
| | | | - Courtney D Cameron
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Kelsey M Haczkewicz
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Caroline Monnin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, Canada
| | - Katie Aubrecht
- Department of Sociology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Iwona Bielska
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Ivy Cheng
- Department of Emergency Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Aislinn Conway
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - Chi-Ling Joanna Sinn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Natasha L Gallant
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada.
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Tosangwarn S, Clissett P, Blake H. Understanding the experience of stigma in care homes: A qualitative case study in northeast Thailand. J Psychiatr Ment Health Nurs 2024; 31:475-491. [PMID: 38063286 DOI: 10.1111/jpm.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 07/03/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Stigma associated with care homes has been found to influence residents' lives, and it is a known risk factor for depression among older adults worldwide. Older residents in Asia and particularly, in Thai care homes commonly experience stigma due to being strongly influenced by a traditional cultural paradigm of filial piety. The understanding of how residents perceive and experience the stigma associated with residing in care homes, as well as its link to the development of depression, remains very limited. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This research explains the dynamics of the process of the stigma associated with living care homes among Thai older residents. This research highlights the various ways in which stigma impacts residents, their families and care home staff. This study identifies mitigating stigma factors, including social support, coping strategies (karma, mindfulness and religious devotions) and activities that may mitigate perceived stigma associated with care home residency. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a compelling need to improve the well-being of older people living in care homes and to combat the cultural stigma associated with living in care homes through promoting positive attitudes and educational interventions in society, communities and care homes themselves and involving residents' families in the planning and delivery of care for residents. We advocate that the government promotes security and sustainable life for all Thai older adults. ABSTRACT INTRODUCTION: Stigma associated with living in care homes is a known risk factor for depression among care home residents in Asia, including Thailand. However, little is understood about how such stigma is experienced among residents and care home staff. AIMS To examine older adults' perceptions of stigma and to understand how stigma associated with living in care homes causes or exacerbates depressive symptoms. METHODS A qualitative case study approach was used to gain an in-depth view of stigma, from two public care homes in northeast Thailand. Data were collected by in-depth interviews with 50 participants (30 older residents and 20 care home staff), and non-participant observation was conducted over 1 month. Thematic analysis was used to analyse the data. RESULTS The study identified three major themes of stigma, comprising the causes of stigma, reactions toward stigma, and mitigating factors. DISCUSSION Negative beliefs about care homes and residents, contribute to stigma. Residents exhibited negative emotions and behaviours, including depressive symptoms. Residents reported using particular coping strategies that helped them cope with their perceptions of stigma. IMPLICATIONS FOR PRACTICE Future research should focus on strategies or research to combat stigma in order to prevent depression and reduce perceptions of stigma.
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Affiliation(s)
- Suhathai Tosangwarn
- Department of Psychiatric Nursing, Boromarajonani College of Nursing, Nakhon Ratchasima, Faculty of Nursing, Praboromarajchanok Institute, Nakhon Ratchasima, Thailand
| | - Philip Clissett
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Sakai T, Jadczak AD, Khalid A, Piovezan RD, Leemaqz S, Visvanathan R. The prevalence of, and factors associated with, a risk of depression in residential aged care services residents: Findings from the FIRST study. Australas J Ageing 2024. [PMID: 39073245 DOI: 10.1111/ajag.13358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 06/01/2024] [Accepted: 06/18/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES Depression is common amongst Australian residential aged care services (RACS) residents. This study aimed to estimate the risk of depression amongst residents and identify factors associated with this risk. In care settings such as RACS, time-efficient screening tools to identify depression risk may be a preferred tool. METHODS The two-item Patient Health Questionnaire (PHQ-2), derived from the nine-item PHQ-9 used commonly in the United States (US), was employed in this study. A resident was identified as being at risk of depression where the score was ≥3. Multivariable logistic regression analysis was used to identify independent factors associated with being at risk of depression. RESULTS Residents' mean age was 87.7 (standard deviation: 7.3) years and 73% were female. One-fifth of residents (n = 108 or 20%) were at risk of depression. Age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99); Pain Assessment in Advanced Dementia (PAINAD) score (OR 1.55, 95% CI 1.11-2.16); Epworth Sleepiness Scale (ESS) score (OR 1.08, 95% CI 1.03-1.13); and 38-item Frailty Index (FI) score (OR 1.07, 95% CI 1.03-1.10) were significantly associated with being at risk of depression, whilst sex, urinary incontinence, polypharmacy, Dementia Severity Rating Scale (DSRS) and Nursing Home Life Space Diameter (NHLSD) score were not. CONCLUSIONS One in five residents were at risk of depression. Younger age, higher pain, higher daytime sleepiness and higher frailty status were associated with depressive risk. Future studies focusing on interventions targeting these factors may contribute to improved health outcomes.
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Affiliation(s)
- Tomomichi Sakai
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Agathe Daria Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ashna Khalid
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ronaldo D Piovezan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Shalem Leemaqz
- South Australian Health and Medical Research Institute (SAHMRI) Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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Longacre ML, Redington S, Miller MF. Participation in a social cluster program among persons in residential living at a continuing care retirement community during COVID. Geriatr Nurs 2024; 59:181-186. [PMID: 39018962 DOI: 10.1016/j.gerinurse.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 06/10/2024] [Accepted: 06/21/2024] [Indexed: 07/19/2024]
Abstract
A Continuing Care Retirement Community (CCRC) initiated a voluntary cohort or "social cluster" (SC) program during the pre-vaccination phase of COVID. SCs are self-selected small groups of persons who decide about types of social interactions. The program began in April 2020, and a cross-sectional survey of residents was conducted in November 2020 to assess perceptions of COVID (e.g., worry and prevention) and of program participation. A secondary goal was to explore if program involvement was associated with perceptions of social isolation. Participants (n = 85) were "somewhat" (49 %) or "very" (11 %) worried about COVID, and 34 % participated in a SC. 89 % of the SC participants indicated that "Dining within 6ft" was most preferred. Improvement in boredom, social isolation, activity level, mental health, hope, and fear was noted among some SC participants (55 %, 52 %, 41 %, 38 %, and 14 %, respectively). Findings contribute to understanding social engagement needs amidst COVID.
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Affiliation(s)
- Margaret L Longacre
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038.
| | - Suzanne Redington
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038
| | - Melissa F Miller
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038; Inova Life with Cancer, Inova Schar Cancer Institute, Fairfax, VA 22031
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Dewan N, Sommerlad A, Chapman H, Banerjee S, Corazzini K, Edvardsson D, Liougas MP, Livingston G, McGilton KS, O'Rourke HM, Bethell J. Assessing social connection for long-term care home residents: Systematic review using COnsensus-based Standards for the selection of health Measurement INstruments guidelines. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12492. [PMID: 39104764 PMCID: PMC11299077 DOI: 10.1002/trc2.12492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 06/05/2024] [Indexed: 08/07/2024]
Abstract
Social connection is important for long-term care (LTC) residents' quality of life and care. However, there is a lack of consensus on how to measure it and this limits ability to find what improves and impairs social connection in LTC homes. We therefore aimed to systematically review and evaluate the measurement properties of existing measures of social connection for LTC residents, to identify which, if any, measures can be recommended. We searched eight electronic databases from inception to April 2022 for studies which reported on psychometric properties of a measure of any aspect(s) of social connection (including social networks, interaction, engagement, support, isolation, connectedness, and loneliness) for LTC residents. We used COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines to evaluate the measurement properties reported for each identified measure and make recommendations. We identified 62 studies reporting on 38 measures; 21 measured quality of life, well-being or life satisfaction and included a social connection subscale or standalone items and 17 measures specifically targeted social connection. We found there was little high-quality evidence on psychometric properties such as sufficient content validity (n = 0), structural validity (n = 3), internal consistency (n = 3), reliability (n = 1), measurement error (n = 0), construct validity (n = 4), criterion validity (n = 0) and responsiveness (n = 0). No measures demonstrated satisfactory psychometric properties on all these aspects, so none could be recommended for use. Thirty-four measures have the potential to be recommended but require further research to assess their quality and the remaining four are not recommended for use. Our review therefore found that no existing measures have sufficient evidence to be recommended for assessment of social connection in residents of LTC homes. Further validation and reliability studies of existing instruments or the development of new measures are needed to enable accurate measurement of social connection in LTC residents for future observational and interventional studies. Highlights Social connection is fundamental to person-centered care in long-term care homes.There is insufficient evidence for the reliability and validity of existing measures.No current measures can be recommended for use based on existing evidence.A reliable and valid measure of social connection is needed for future research.
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Affiliation(s)
- Neha Dewan
- KITE Research InstituteToronto Rehabilitation Institute – University Health NetworkTorontoOntarioCanada
- Department of Physical Therapy EducationCollege of Health SciencesWestern University of Health SciencesOregonUSA
| | - Andrew Sommerlad
- Division of PsychiatryUniversity College LondonLondonUK
- Camden and Islington NHS Foundation TrustLondonUK
| | | | - Sube Banerjee
- Faculty of Medicine and Health SciencesUniversity of NottinghamNottinghamUK
| | - Kirsten Corazzini
- College of Health and Human ServicesThe University of New HampshireDurhamUSA
| | - David Edvardsson
- School of Nursing and MidwiferyLa Trobe UniversityMelbourneVictoriaAustralia
- Sahlgrenska AcademyInstitute of Health and Care SciencesUniversity of GothenburgGothenburgSweden
| | - Madalena P. Liougas
- KITE Research InstituteToronto Rehabilitation Institute – University Health NetworkTorontoOntarioCanada
- Rehabilitation Sciences InstituteTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Gill Livingston
- Division of PsychiatryUniversity College LondonLondonUK
- Camden and Islington NHS Foundation TrustLondonUK
| | - Katherine S. McGilton
- KITE Research InstituteToronto Rehabilitation Institute – University Health NetworkTorontoOntarioCanada
- Rehabilitation Sciences InstituteTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
| | | | - Jennifer Bethell
- KITE Research InstituteToronto Rehabilitation Institute – University Health NetworkTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
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Autschbach D, Hagedorn A, Halek M. Addressing loneliness and social isolation through the involvement of primary and secondary informal caregivers in nursing homes: a scoping review. BMC Geriatr 2024; 24:552. [PMID: 38918689 PMCID: PMC11197341 DOI: 10.1186/s12877-024-05156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES To clarify the mechanisms of interventions addressing loneliness and social isolation in older adults living in nursing homes through the involvement of primary and secondary informal caregivers. METHODS This scoping review was performed by two independent reviewers, covering the period between 2011 and 2022 and the databases MEDLINE, CINAHL, PsycINFO and Scopus. It included terms related to (A) informal caregivers, (B) nursing homes, (C) psychosocial interventions, (D) involvement and (E) social isolation or loneliness. RESULTS Thirty-three studies met the inclusion criteria. Although there were various definitions and assessment tools related to social isolation and loneliness, the studies referred to three dimensions of these concepts in nursing home residents: the quantity of social interactions, the perception of these encounters and biographical changes in social relationships. Most studies did not explicate the mechanisms of these interventions. The review uncovered the following aspects of intervention mechanisms: increasing opportunities for social contact, creating meaningful encounters, maintaining existing relationships with primary informal caregivers and establishing new ones with secondary informal caregivers. CONCLUSION Studies reporting on interventions addressing loneliness and social isolation in nursing home residents need to clarify and detail their intervention mechanisms in order to foster more targeted interventions. In addition, there is a need for further research on large-scale programs or care philosophies in this field and the development of intervention designs, which allow for tailored intervention formats in order to respond to the individual perception of social relationships.
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Affiliation(s)
- Dominique Autschbach
- School of Nursing Science, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Anika Hagedorn
- School of Nursing Science, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Margareta Halek
- School of Nursing Science, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
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Hardy MS, Fanaki C, Savoie C, Wilchesky M, Gagnon MP, Laberge M, Couture V, Côté A, Dallaire C, Voyer P, Gallani MC, Dallaire B, Gagnon É. Long-term care staffs' experience in facilitating the use of videoconferencing by cognitively impaired long-term care residents during the COVID-19 pandemic: a mixed-methods study. BMC Health Serv Res 2024; 24:646. [PMID: 38769512 PMCID: PMC11106931 DOI: 10.1186/s12913-024-11095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 05/09/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, numerous long-term care (LTC) homes faced restrictions that prevented face-to-face visits. To address this challenge and maintain family connections, many LTC homes facilitated the use of electronic tablets to connect residents with their family caregivers. Our study sought to explore the acceptability of this practice among staff members and managers, focusing on their experiences with facilitating videoconferencing. METHODS A convergent mixed method research was performed. Qualitative and quantitative data collection through semi-structured interviews to assess the acceptability of videoconferencing in long-term care homes and to explore the characteristics of these settings. Quantitative data on the acceptability of the intervention were collected using a questionnaire developed as part of the project. The study included a convenience sample of 17 staff members and four managers. RESULTS Managers described LTC homes' characteristics, and the way videoconferencing was implemented within their institutions. Affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, and self-efficacy are reported as per the constructs of the Theoretical Framework of Acceptability. The results suggest a favorable acceptability and a positive attitude of managers and staff members toward the use of videoconferencing in long-term care to preserve and promote contact between residents and their family caregivers. However, participants reported some challenges related to the burden and the costs regarding the invested time and staff shortage. CONCLUSIONS LTC home staff reported a clear understanding of the acceptability and challenges regarding the facilitation of videoconferencing by residents to preserve their contact with family caregivers.
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Affiliation(s)
- Marie-Soleil Hardy
- Faculty of Nursing Science, Université Laval, Québec, QC, G1V 0A6, Canada.
| | - Chaimaa Fanaki
- Faculty of Nursing Science, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Camille Savoie
- Faculty of Nursing Science, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Machelle Wilchesky
- Department of Family Medicine and Division of Geriatric Medicine, McGill University, Montreal, QC, H3S 1Z1, Canada
| | | | - Maude Laberge
- Faculty of Administration, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Vincent Couture
- Faculty of Nursing Science, Université Laval, Québec, QC, G1V 0A6, Canada
| | - André Côté
- Faculty of Administration, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Clémence Dallaire
- Faculty of Nursing Science, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Philippe Voyer
- Faculty of Nursing Science, Université Laval, Québec, QC, G1V 0A6, Canada
| | | | | | - Éric Gagnon
- Faculty of Social Sciences, Université Laval, Québec, QC, G1V 0A6, Canada
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Harris C, Sumy MSA, Feygin YB, Huxol H, Tejuoso A, Kluthe T, Bickel S. Changes in Psychiatric Medication Use During the COVID-19 Pandemic in a Pediatric Long-Term Care Facility. J Child Adolesc Psychopharmacol 2024; 34:210-213. [PMID: 38682450 DOI: 10.1089/cap.2023.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background: Coronavirus disease 2019 (COVID-19) caused a global pandemic that dramatically altered infection control procedures in long-term care facilities. Mental health decline among residents of geriatric facilities during the pandemic has been described (Ferro Uriguen et al., 2022). Our study aims to evaluate psychological effects of the pandemic on residents of a pediatric long-term care facility, a population comprised of medically complex children. To characterize this, we compared patterns of psychotropic medication use during the COVID-19 pandemic to those of the prepandemic period among residents of a 76-bed pediatric long-term care facility. Methods: We conducted a retrospective study of psychotropic medication use from January 2019 to August 2022 using de-identified monthly facility medication refill data. Linear multivariable regression models were used to estimate the level and trends in the monthly rates of medication refills per 10,000 bed days among resident children before and after the pandemic onset. Six classes of psychotropic medications were analyzed including antipsychotics, antidepressants and anxiety medications, trazodone, clonidine, mood stabilizers, and gabapentin. Results: The pandemic onset was associated with a significant increase in the monthly prescribing rates of antidepressant and anxiety medications (20.83; 95% CI, 3.96-37.71; p = 0.017), mood stabilizers (10.44; 95% CI, 5.79-15.09; p < 0.001), and trazodone (-27.66; 95% CI, -40.44 to 14.88; p < 0.001) above those expected by prepandemic trends. The trend in trazodone use changed significantly during the pandemic from decreasing prepandemic to increasing (2.21; 95% CI, 1.28-3.14; p < 0.001). Antidepressant, anxiety medication, and gabapentin use increased throughout the study. Antidepressant and anxiety medication use surged early in the pandemic, but then continued growth at their prior rates of use. Discussion: Increased use of antidepressant and anxiety medications and trazodone suggests a possible impact of the COVID-19 pandemic on rates of anxiety, depression, sleep disturbance, and agitation among children with severe intellectual and developmental disabilities living in long-term care.
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Affiliation(s)
- Corrie Harris
- Division of Pediatric Hospitalist Medicine, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Mst Sharmin Akter Sumy
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky, USA
| | - Yana B Feygin
- Norton Children's Research Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Heather Huxol
- Division of Pediatric Hospitalist Medicine, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Ademilola Tejuoso
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Theresa Kluthe
- Norton Children's Research Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Scott Bickel
- Division of Pediatric Pulmonology, Allergy and Immunology, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
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11
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Misiak MM, Bethell J, Chapman H, Sommerlad A. How can care home activities facilitate social connection in residents? A qualitative study. Aging Ment Health 2024:1-10. [PMID: 38669150 DOI: 10.1080/13607863.2024.2345130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/13/2024] [Indexed: 04/28/2024]
Abstract
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.
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Affiliation(s)
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute,University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Andrew Sommerlad
- Division of Psychiatry, University College London, UK
- Division of Psychiatry, Camden and Islington NHS Foundation Trust, London, UK
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12
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Shen Y, Luo SW, Liu HL, Zhao YY. The Effectiveness of Interventions for Reducing Loneliness Among Chinese Older Adults: A Systematic Review and Meta-Analysis. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-22. [PMID: 38598564 DOI: 10.1080/01634372.2024.2339976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
This review assesses interventions to reduce loneliness in Chinese older adults, analyzing 36 studies involving 3965 participants. Focusing on individuals aged 50 and over, the meta-analysis reveals a significant overall effect size (Hedges' g = 0.937, 95% CI [0.71,1.16], p<0.001), highlighting the effectiveness of psychological and mixed-method approaches. Despite promising results, methodological concerns suggest cautious interpretation. Future research should aim to refine intervention quality and examine the impact of technology-supported methods on loneliness.
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Affiliation(s)
- Yan Shen
- School of Economic & Management and Law, Hubei Normal University, Huangshi, China
| | - Shi W Luo
- School of Economic & Management and Law, Hubei Normal University, Huangshi, China
| | - Hou L Liu
- Data Experiment Department, China Population and Development Research Center
| | - Yan Y Zhao
- School of Economic & Management and Law, Hubei Normal University, Huangshi, China
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13
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Conklin J, Dehcheshmeh MM, Archibald D, Elliott J, Hsu A, Kothari A, Stolee P, Sveistrup H. From Compliance to Care: Qualitative Findings from a Survey of Essential Caregivers in Ontario Long-Term Care Homes. Can J Aging 2024:1-10. [PMID: 38561989 DOI: 10.1017/s071498082400014x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic highlighted the importance of the care provided by family members and close friends to older people living in long-term care (LTC) homes. Our implementation science team helped three Ontario LTC homes to implement an intervention to allow family members to enter the homes during pandemic lockdowns. OBJECTIVE We used a variety of methods to support the implementation, and this paper reports results from an Ontario-wide survey intended to help us understand the nature of the care provided by family caregivers. METHODS We administered a survey of essential caregivers in Ontario, and a single open-ended question yielded a substantial qualitative data set that we analysed with a coding and theming procedure that yielded 13 themes. FINDINGS The 13 themes reveal deficiencies in Ontario's LTC sector, attempts to cope with the deficiencies, and efforts to influence change and improvement. DISCUSSION Our findings indicate that essential caregivers find it necessary to take on vital roles in order to shore up two significant gaps in the current system: they provide psychosocial and emotional (and sometimes even basic) care to residents, and they play a monitoring and advocacy role to compensate for the failings of the current regulatory compliance regime.
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Affiliation(s)
- James Conklin
- Department of Applied Human Sciences, Concordia University, Montreal, QC, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | | | - Douglas Archibald
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jacobi Elliott
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Amy Hsu
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Anita Kothari
- School of Health Studies, Western University, London, ON, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Heidi Sveistrup
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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14
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Weidner M, Towsley GL. Meaningful connections: An education program to enhance resident-certified nursing assistant relationships. GERONTOLOGY & GERIATRICS EDUCATION 2024; 45:259-275. [PMID: 36752118 DOI: 10.1080/02701960.2023.2174116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Close relationships between nursing home residents and Certified Nursing Assistants (CNAs) result in positive outcomes for both residents and staff, including increased well-being for residents. However, many resident-CNA relationships remain superficial, are focused primarily on physical care, and interpersonal skill training for CNAs is sparse. The purpose of this study was to develop an education program to foster CNAs' interpersonal skills and relationship development. We conducted a literature review on CNA interpersonal skill training and disseminated a survey to CNAs to inform the education program. Literature review findings revealed that CNAs value their relationships with residents and desire more interpersonal training, but this training is often limited. The survey, which was disseminated via social media and facility contact referrals, asked responding CNAs (n = 73) to evaluate their perceptions of empowerment, interpersonal skill competency, and learning preferences. We found that most CNAs feel confident in their interpersonal skills, but they lack training in boundary-setting and bereavement support. About one-third of respondents did not feel that their work was valued or their strengths recognized by their supervisors. Most respondents reported that they valued visual (85%), experiential (91%) learning. The final program, Meaningful Connections, includes nine modules covering topics such as person-centered caregiving, empathy, emotional intelligence, and boundary-setting. One supplementary module provides potential adaptations to the curriculum to customize the needs of each participant group. The results of this project suggest a need for more CNA relationship training and support, especially in the areas of boundary-setting and bereavement.
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Affiliation(s)
- Michelle Weidner
- University of Utah College of Nursing, Salt Lake City, UT, United States
| | - Gail L Towsley
- University of Utah College of Nursing, Salt Lake City, UT, United States
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15
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Ysseldyk R, Morton TA, Haslam C, Haslam SA, Boger J, Giau E, Macdonald EP, Matharu A, McCoy M. 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. Can J Aging 2024; 43:45-56. [PMID: 37501571 DOI: 10.1017/s0714980823000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
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.
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Affiliation(s)
- Renate Ysseldyk
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | | | - Catherine Haslam
- School of Psychology, The University of Queensland, Brisbane, QL, Australia
| | - S Alexander Haslam
- School of Psychology, The University of Queensland, Brisbane, QL, Australia
| | - Jennifer Boger
- Systems Design Engineering, University of Waterloo, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
| | - Emily Giau
- Systems Design Engineering, University of Waterloo, ON, Canada
| | - Erin P Macdonald
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Amy Matharu
- Research Institute for Aging, Waterloo, ON, Canada
| | - Madeline McCoy
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
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16
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Sugimori E, Yamaguchi M, Kusumi T. Writing to your past-self can make you feel better. Front Psychol 2024; 15:1327595. [PMID: 38476384 PMCID: PMC10927754 DOI: 10.3389/fpsyg.2024.1327595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
Self-compassionate writing has been shown to be helpful for improving the mental state in some individuals. Here, we investigated how the writer's attitude toward his/her past, present and future and the focus of the writing, i.e., social experience in the past versus self-experience, modulate these effects. In Experiment 1, 150 undergraduates wrote a compassionate letter to their past-self and to their future-self and responded to the Japanese version of the Adolescent Time Inventory-Time Attitudes (ATI-TA) questionnaire. Writing to past-self decreased negative feelings more than writing to future-self. Further, participants who had negative feelings toward their past, present, and future, as assessed by the ATI-TA, were more likely to be emotionally affected by writing a letter to their past-self. In Experiment 2, 31 undergraduates wrote a letter focusing on what they had experienced together with someone, and another 31 undergraduates wrote focusing on what they had experienced alone. Focusing on a social experience was more helpful for recovering from negative feelings than focusing on a self-experience. In conclusion, writing a compassionate letter to one's past-self can improve mood, especially in individuals with a negative time attitude who focus their writing on a social connection.
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Affiliation(s)
- Eriko Sugimori
- School of Human Sciences, Faculty of Human Sciences, Waseda University, Tokyo, Japan
| | - Mayu Yamaguchi
- School of Human Sciences, Faculty of Human Sciences, Waseda University, Tokyo, Japan
| | - Takashi Kusumi
- Division of Cognitive Psychology in Education, Graduate School of Education, Kyoto University, Kyoto, Japan
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17
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Flynn A, Brennan A, Barry M, Redfern S, Casey D. Social connectedness and the role of virtual reality: experiences and perceptions of people living with dementia and their caregivers. Disabil Rehabil Assist Technol 2024:1-15. [PMID: 38372257 DOI: 10.1080/17483107.2024.2310262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE People living with dementia are often at increased risk of becoming socially disconnected due to dementia-related challenges. In recent years, digital technology has been designed to help address the social health of people living with dementia and provide opportunities to promote or maintain their social connectedness. This paper presents the findings from phase two of a participatory action research project, which explored people living with dementia and their caregiver's experiences and perceptions of social connectedness and the potential role of Virtual Reality (VR) in promoting or maintaining same. MATERIALS AND METHODS People living with dementia (n = 8) and their informal caregivers (n = 8) participated in an individual, 1:1 online interview. Data analysis was guided by reflexive thematic analysis. RESULTS The findings presented four themes: social connectedness: lived experiences and insights, facilitating social connectedness, barriers to social connectedness and the potential of multi-user VR for social connectedness. People living with dementia experienced a range of personal, community and societal connectedness. Facilitators of social connectedness included supportive, non-judgemental, and reciprocal relationships, technology adoption, and personal and contextual facilitators. Dementia-related difficulties and periods of disruption or change were considered barriers to social connectedness. Multi-user VR was perceived as useful for promoting and maintaining social connectedness. CONCLUSIONS The perceived usefulness of multi-user VR for social connectedness indicates its potential for use with this population. Understanding the lived experiences, barriers, and facilitators of social connectedness will assist researchers and the human-computer interaction community to inform the design of future multi-user VR for social connectedness outcomes with people living with dementia and their caregivers.
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Affiliation(s)
- Aisling Flynn
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, University of Galway, Galway, Ireland
| | - Marguerite Barry
- Information and Communication Studies, ADAPT Centre, University College Dublin, Ireland
| | - Sam Redfern
- School of Computer Science, University of Galway, Galway, Ireland
| | - Dympna Casey
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
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18
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Liougas MP, Sommerlad A, O'Rourke HM, McGilton KS, Bethell J. Social connection measures for older adults living in long-term care homes: a systematic review protocol. Syst Rev 2024; 13:67. [PMID: 38360642 PMCID: PMC10867987 DOI: 10.1186/s13643-024-02468-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Various measures have assessed social connection in long-term care (LTC) home residents. However, they use inconsistent terminology, conceptualizations, and operationalizations of social connection. In this systematic review protocol, we propose a study that will characterize measures that assess aspects of LTC home residents' social connection using a unified conceptual model. The objectives are to (1) describe and analyze the measures and (2) evaluate their measurement properties. METHODS A literature search was conducted in MEDLINE ALL (Ovid), Embase Classic and Embase (Ovid), Emcare Nursing (Ovid), APA PsycInfo (Ovid), Scopus, CINAHL Complete (EBSCOhost), AgeLine (EBSCOhost), and Sociological Abstracts (ProQuest). We will include primary research papers with no language limit, published from database inception. We will include studies of a measure of any aspect of social connection in LTC home residents that report at least one measurement property. Independently, two reviewers will screen titles and abstracts, review full-text articles against eligibility criteria, and extract data from included studies. In objective 1, we will analyze identified tools using an adapted framework method. In objective 2, we will evaluate each measure's measurement properties using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. We will engage experts and stakeholders to assist with interpreting results and translating knowledge. DISCUSSION Our findings will inform the social connection in long-term care home residents (SONNET) study's development of a novel, person-centered measure for social connection in LTC home settings. We will present our findings in academic and non-academic forums, including conferences, peer-reviewed journals, and other publications. SYSTEMIC REVIEW REGISTRATION Prospero-"Systematic review of measures of social connection used in long-term care home research." CRD42022303526 .
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Affiliation(s)
- Madalena P Liougas
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON, Canada.
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Hannah M O'Rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Alberta, Canada
| | - Katherine S McGilton
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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19
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Montoya A, Park P, Bynum J, Chang CH. Transfer Trauma Among Nursing Home Residents: Development of a Composite Measure. THE GERONTOLOGIST 2024; 64:gnad085. [PMID: 37392460 DOI: 10.1093/geront/gnad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing home (NH)-to-NH transfers place NH residents at risk for developing transfer trauma. We aimed to develop a composite measure of transfer trauma and apply it among those transferring before and during the pandemic. RESEARCH DESIGN AND METHODS Cross-sectional cohort analysis of long-stay NH residents with a NH-to-NH transfer. Minimum Data Set data (2018-2020) were used to create the cohorts. A composite measure of transfer trauma was developed (2018 cohort) and applied to the 2019 and 2020 cohorts. We analyzed resident characteristics and conducted logistic regression analyses to compare rates of transfer trauma between periods. RESULTS In 2018, 794 residents were transferred; 242 (30.5%) met the criteria for transfer trauma. In the 2019 and 2020, 750 residents (2019) and 795 (2020) were transferred. In 2019 cohort, 30.7% met the criteria for transfer trauma, and 21.9% in 2020 cohort. During the pandemic, a higher proportion of transferred residents left the facility before the first quarterly assessment. Among residents who stayed in NH for their quarterly assessment, after adjusting for demographic characteristics, residents in the 2020 cohort were less likely to experience transfer trauma than those in the 2019 cohort (adjusted odds ratio [AOR] = 0.64, 95% confidence interval [CI]: 0.51, 0.81). However, residents in 2020 cohort were two times more likely to die (AOR = 1.94, 95% CI: 1.15, 3.26) and 3 times more likely to discharge within 90 days after transfer (AOR = 2.86, 95% CI: 2.30, 3.56) compared with those in 2019 cohort. DISCUSSION AND IMPLICATIONS These findings highlight how common transfer trauma is after NH-to-NH transfer and the need for further research to mitigate negative outcomes associated with the transfer in this vulnerable population.
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Affiliation(s)
- Ana Montoya
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Pil Park
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Julie Bynum
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Chiang-Hua Chang
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
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20
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Akhtar SA. Socially connected while apart: the use of technology to increase social connection between nursing home residents and their relatives. Front Public Health 2024; 12:1296524. [PMID: 38333742 PMCID: PMC10850371 DOI: 10.3389/fpubh.2024.1296524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction This study examines whether the use of a communication technology can enhance social connectedness among nursing home residents in Norway. The concept of social connectedness suggest that positive and significant interpersonal relationships can help reduce the risk of loneliness and social isolation among older adults and can be beneficial for both their health and overall well-being. In recent years, technology has been increasingly utilized as a method to overcome physical distances and to keep families connected. Although the use of digital solutions among older people has increased in recent years, few studies have addressed the use and impact of such technologies within a nursing home context. Methods A total of 225 residents participated in the study, making it one of the few quantitative studies that examine the use of communication technologies in nursing homes at such a large scale. The study combines two sources of data: (1) survey data collected over a 14-month period, in three different waves, at all public nursing homes in Oslo municipality and (2) a highly detailed weekly datastream from each Komp-device, which provides an objective measure of the frequency of contact between the residents and their families. The two sources of data were combined and analyzed using multiple regression analysis. Results The regression analysis revealed a positive and significant relationship between Komp use and increased social satisfaction among the residents. The results indicate that Komp is a feasible communication tool to help nursing home residents maintain relations with their families. Discussion The positive response to Komp among the residents suggests that when designed with the user's needs in mind, technology can indeed facilitate meaningful social interactions, even for those with limited technological experience. Such interventions can thus be crucial in bridging the gap between older residents and the outside world, effectively addressing their unique challenges of social isolation and disconnection from the broader community.
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Affiliation(s)
- Sehrish Andleeb Akhtar
- Faculty of Social Sciences, Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, Norway
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21
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Hutchinson C, Cleland J, McBain C, Walker R, Milte R, Swaffer K, Ratcliffe J. What quality of life domains are most important to older adults in residential care? J Aging Soc Policy 2024; 36:21-42. [PMID: 36252046 DOI: 10.1080/08959420.2022.2134691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/14/2022] [Indexed: 10/24/2022]
Abstract
Quality of life is a critically important outcome measure in aged care. However, few studies have provided a detailed examination of what quality of life means to older adults living in residential care. In the current study, N = 43 older adults (67 to 99 years) living in six residential aged care facilities in four Australian states took part in semi-structured interviews. Participants had normal cognition through to mild /moderate cognitive impairment as measured by the PAS-Cog, were able to provide informed consent, and could participate in an interview conducted in English. Interviews were transcribed, and data was analyzed in NVivo using thematic analysis. Both physical and psycho-social aspects were identified as important for older adults' quality of life with six key quality of life domains identified: independence, mobility, pain management, social connections, emotional well-being, and activities. More research is needed to test these domains with a more diverse sample of older adults living in residential aged care, in particular older adults from culturally and linguistically diverse communities. Such qualitative work is essential for the development of suitable quality of life measures for this population and provides valuable information to inform improvements to care practices and service provision. Some ways in which the identified quality of life domains could be used to enhance care provision are discussed.
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Affiliation(s)
- Claire Hutchinson
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Jenny Cleland
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Candice McBain
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Ruth Walker
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Kate Swaffer
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- School of Society and Justice, University of South Australia, Magill, SA 5072, Australia
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Dubé CE, Nielsen N, McPhillips E, Lee Hargraves J, Cosenza C, Jesdale B, Lapane KL. U.S. nursing home leadership experiences with COVID-19 and its impact on residents and staff: A qualitative analysis. PLoS One 2023; 18:e0293336. [PMID: 38113231 PMCID: PMC10729989 DOI: 10.1371/journal.pone.0293336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 10/10/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVES To explore experiences of U.S. (United States) nursing home leadership during the COVID-19 pandemic in their efforts to address resident loneliness and social isolation and to elicit stories about personal and professional impacts on themselves and staff. DESIGN Qualitative inquiry via three optional open-ended questions appended to a national self-administered survey of American nursing home leaders was employed. Textual data was analyzed using an iterative reflexive thematic approach. SETTING AND PARTICIPANTS A stratified sample frame defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5) was employed. Web survey links and paper surveys were sent to 1,676 nursing home directors of nursing between February and May 2022. RESULTS Open text responses were collected from 271 nursing homes. Broad themes included: 1) Addressing needs of residents & families; 2) Challenges; and 3) Personal experiences of nursing home leadership/staff. Respondents described trauma to residents, staff, and leadership. Resident loneliness was addressed using existing and newer technologies and innovative indoor and outdoor activities. Residents experienced fear, illness, loss, and sometimes death. Isolation from family and lack of touch were particularly difficult. Regulations were seen as punitive while ignoring emotional needs of residents. Staffing challenges and pressures to do more with less created additional stress. Leadership and staff made significant sacrifices resulting in physical, social, and emotional consequences. Beneficial outcomes included staff bonding, professional growth, and permanent implementation of new interventions. CONCLUSIONS AND IMPLICATIONS New and creative interventions were successfully implemented to address social isolation and loneliness. Improved Wi-Fi and other nursing home infrastructure upgrades are needed to maintain them. Reimagining often conflicting overlapping federal, state, and local regulations, grounding them in good clinical judgement, and incentivizing performance improvement should be considered. Trauma experienced by staff needs to be addressed to deal with current and future workforce needs.
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Affiliation(s)
- Catherine E. Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - Natalia Nielsen
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - Emily McPhillips
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - J. Lee Hargraves
- Department of Family Medicine and Community Health University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
- Center for Survey Research, University of Massachusetts Boston, Boston, Massachusetts, United States of America
| | - Carol Cosenza
- Center for Survey Research, University of Massachusetts Boston, Boston, Massachusetts, United States of America
| | - Bill Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
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Craig S, Cao Y, McMahon J, Anderson T, Stark P, Brown Wilson C, Creighton L, Gonella S, Bavelaar L, Vlčková K, Mitchell G. Exploring the Holistic Needs of People Living with Cancer in Care Homes: An Integrative Review. Healthcare (Basel) 2023; 11:3166. [PMID: 38132056 PMCID: PMC10743280 DOI: 10.3390/healthcare11243166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Up to 26% of individuals residing in care homes are impacted by cancer. This underscores the importance of understanding the holistic needs of care home residents living with cancer to enhance the quality of their care. The primary objective of this integrative literature review was to consolidate the available evidence concerning the comprehensive needs of people living with cancer in care home settings, providing valuable insights into addressing their diverse needs. An integrative literature review was conducted using a systematic approach. Extensive searches were conducted in three databases, complemented by a thorough examination of grey literature and reference lists of relevant papers. The review focused on literature published between 2012 and 2022. The screening process involved two independent reviewers, with a third reviewer resolving any discrepancies. The review identified twenty research papers that met the eligibility criteria. These papers shed light on three primary themes related to the holistic needs of care home residents with cancer: physical, psychological, and end-of-life needs. Physical needs encompassed pain management, symptom control, and nutrition, while psychological needs involved social support, emotional well-being, and mental health care. End-of-life needs addressed end-of-life care and advance care planning. These themes highlight the multifaceted nature of cancer care in care homes and underscore the importance of addressing residents' holistic needs in a comprehensive and integrated manner. Improving care home education about cancer and integrating palliative and hospice services within this setting are vital for addressing the diverse needs of residents with cancer.
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Affiliation(s)
- Stephanie Craig
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Yanting Cao
- The Shanghai Medical College, Fudan University, Shanghai 200437, China;
- Stellar Care NW Ltd., Ellesmere Port CH65 1A, UK
| | - James McMahon
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Tara Anderson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Patrick Stark
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Christine Brown Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Laura Creighton
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Silvia Gonella
- Direction of Health Professions, City of Health and Science University Hospital of Torino, Corso Bramante 88-90, 10126 Turin, Italy;
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Turin, Italy
| | - Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | | | - Gary Mitchell
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
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Reid JC, Carbone S, Shaw JF, Gallibois M, Hawkins SA. "My Biggest Fear Is She'll Die Alone": Care Partner Perspectives of Institutional COVID-19 Visitor Restrictions in Ontario, Canada. Can J Aging 2023; 42:710-718. [PMID: 37287305 DOI: 10.1017/s071498082300017x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
In March 2020, the Government of Ontario, Canada implemented public health measures, including visitor restrictions in institutional care settings, to protect vulnerable populations, including older adults (> 65 years), against COVID-19 infection. Prior research has shown that visitor restrictions can negatively influence older adults' physical and mental health and can cause increased stress and anxiety for care partners. This study explores the experiences of care partners separated from the person they care for because of institutional visitor restrictions during the COVID-19 pandemic. We interviewed 14 care partners between the ages of 50 and 89; 11 were female. The main themes that emerged were changing public health and infection prevention and control policies, shifting care partner roles as a result of visitor restrictions, resident isolation and deterioration from the care partner perspective, communication challenges, and reflections on the impacts of visitor restrictions. Findings may be used to inform future health policy and system reforms.
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Affiliation(s)
- Julie C Reid
- Canadian Frailty Network/Le Réseau Canadien des soins aux personnes fragilisées, Kidd House, Kingston, ON, Canada
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Sarah Carbone
- Canadian Frailty Network/Le Réseau Canadien des soins aux personnes fragilisées, Kidd House, Kingston, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Julia F Shaw
- Canadian Frailty Network/Le Réseau Canadien des soins aux personnes fragilisées, Kidd House, Kingston, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Molly Gallibois
- Canadian Frailty Network/Le Réseau Canadien des soins aux personnes fragilisées, Kidd House, Kingston, ON, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
| | - Stacey A Hawkins
- Canadian Frailty Network/Le Réseau Canadien des soins aux personnes fragilisées, Kidd House, Kingston, ON, Canada
- Ontario Tech University, Oshawa, ON, Canada
- Seniors Care Network, Port Hope, ON, Canada
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O'Rourke HM, Jeffery N, Walsh B, Quark S, Sidani S. Understanding Acceptability of Group Leisure Activities Used to Address Loneliness Among People Living With Dementia: An Exploratory Mixed-Methods Study. Can J Aging 2023; 42:565-575. [PMID: 37492945 DOI: 10.1017/s0714980823000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
This mixed-methods complementarity study explored family members', friends', and health care providers' perspectives of acceptability of group leisure activities as an intervention for loneliness experienced by older adults living with dementia. A sample of 25 family members, friends, and health care providers of people living with dementia in ON rated the acceptability of group leisure activities (adapted Treatment Perception and Preference questionnaire) and discussed their ratings in an interview. Quantitative (descriptive statistics) and qualitative (conventional content analysis) results were integrated to understand acceptability. Participants viewed group leisure activities as effective, logical, and suitable for use with people living with dementia. Participants described the need for flexible programs, careful facilitation, and attention to activity selection. Group leisure activities were seen as low risk, but stigmas related to dementia could prevent participation. The findings inform the design of acceptable group leisure activities, promoting their use to address loneliness in people living with dementia.
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Affiliation(s)
- Hannah M O'Rourke
- Faculty of Nursing, University of Alberta Level 3, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Nicole Jeffery
- School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Brittany Walsh
- Faculty of Nursing, University of Alberta Level 3, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Sheylenne Quark
- Faculty of Nursing, University of Alberta Level 3, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Souraya Sidani
- School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
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Cruise D, Sinden D, Jaana M. Older Adults' Quality of Life in Long-Term Care: A Cross-Sectional Comparison Before and During the COVID-19 Pandemic. Can J Aging 2023; 42:744-753. [PMID: 37424446 DOI: 10.1017/s0714980823000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
This study aims to assess changes in long-term care (LTC) residents' quality of life (QoL) before and during the COVID-19 pandemic. A pre-test post-test study of 49 QoL measures, across four dimensions from the interRAI self-reported QoL survey, was conducted. Secondary data from 2019 (n = 116) and 2020 (n = 128) were analysed to assess the change in QoL. A significant decline in 12 measures was observed, indicating a change in QoL of LTC residents during the pandemic. Social life was the dimension mostly affected with residents reporting less opportunities to spend time with like-minded residents, explore new skills and interests, participate in meaningful religious activities, and have enjoyable things to do in the evenings. Several measures of personal control, staff responsiveness and care, and safety also demonstrated a significant change. The results can inform future strategies for pandemic and outbreak preparedness. Balancing the safety of residents with attention to their QoL should be a priority moving forward.
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Affiliation(s)
- Danielle Cruise
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Danielle Sinden
- Centre of Excellence in Frailty-Informed CareTM, Perley Health, Ottawa, ON, Canada
| | - Mirou Jaana
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
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DesChâtelets JR, Khowaja AR, Mechelse K, Koning H, Ventresca D. Exploring the Access and Use of Social Technologies by Older Adults in Support of Their Mental Health During the COVID-19 Pandemic: A Rapid Review. Can J Aging 2023; 42:728-743. [PMID: 37727886 DOI: 10.1017/s0714980823000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Coronavirus disease (COVID-19) lockdowns disproportionately affect older people where most suffer from social isolation and loneliness, which translate into higher rates of depression and anxiety. This study aimed to explore the accessibility, outcomes, and challenges of social technology use among community-dwelling older adults, older adults in long-term care, older adults with neurocognitive disorder, and older adults with pre-frailty and frailty, to help guide future research in this area. A rapid review was conducted, and articles were retrieved from four online databases, including Medline, AgeLine, EconLit and CINAHL, and grey literature from Google Scholar. Of the 131 articles retrieved, 24 were included in this review. The positive outcomes of social technology use include improved mental and physical health, reduced health disparities, and increased autonomy. Adverse outcomes include furthering the digital divide. More research surrounding the economic impacts of social technologies is warranted.
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de Lacerda TTB, Assis MG, de Carvalho PF, Pereira LSM. Did managers of long-term care facilities neglect the functionality of older adults? A survey during the COVID-19 pandemic. Am J Infect Control 2023; 51:1350-1355. [PMID: 37149265 PMCID: PMC10158166 DOI: 10.1016/j.ajic.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
Physical distancing impaired the health of older adults living in long-term care facilities (LTCF). This study aimed to assess the perception of managers of Brazilian LTCF about the loss of functionality of residents and strategies to prevent it. In this cross-sectional study, 276 managers of LTCF from all Brazilian regions responded to an online survey, following the Checklist for Reporting Results of Internet E-Surveys. The managers reported a loss of cognitive (60.2%) and physical (48.2%) functionality and more depressive symptoms (77.9%) and falls (16.3%) in residents. In addition, 73.2% of LTCFs reduced in-person activities, and 55.8% did not perform remote activities. Managers of LTCF neglected the functionality of residents. Thus, health surveillance, prevention, and care must be reinforced for this population.
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Lim E, Nielsen N, Lapane L, Barooah A, Xu S, Qu S, McPhillips E, Dube CE, Lapane K. Health effects of social connectedness in older adults living in congregate long-term care settings: A systematic review of quantitative and qualitative evidence. Int J Older People Nurs 2023; 18:e12577. [PMID: 37803996 PMCID: PMC10843483 DOI: 10.1111/opn.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/21/2023] [Accepted: 09/17/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND The overall impact of social connectedness on health outcomes in older adults living in nursing homes and assisted living settings is unknown. Given the unclear health impact of social connectedness for older adults in congregate long-term care settings worldwide, a comprehensive systematic review is required to evaluate the overall relationship between social connectedness and health outcomes for them. OBJECTIVES The purpose of this article was to synthesize the literature regarding the health impact of social connectedness among older adults living in nursing homes or assisted living settings. METHODS Using PRISMA guidelines, we identified eligible studies from Scopus, MEDLINE, PsycINFO, CINAHL and Cochrane databases (1990-2021). Bias and quality reporting assessment was performed using standardized criteria for cohort, cross sectional and qualitative studies. At each stage, ≥ 2 researchers conducted independent evaluations. RESULTS Of the 7350 articles identified, 25 cohort (follow-up range: 1 month-11 years; with two also contributing to cross sectional), 86 cross sectional, eight qualitative and two mixed methods were eligible. Despite different instruments used, many residents living in nursing homes and assisted living settings had reduced social engagement. Quantitative evidence supports a link between higher social engagement and health outcomes most studied (e.g. depression, quality of life). Few studies evaluated important health outcomes (e.g. cognitive and functional decline). Most cohort studies showed that lack of social connectedness accelerated time to death. CONCLUSIONS Social connectedness may be an important modifiable risk factor for adverse health outcomes for older adults living in nursing homes and assisted living facilities. Most studies were cross sectional and focused on quality of life and mental health outcomes. Longitudinal studies suggest that higher social engagement delays time to death. Evidence regarding other health outcomes important to older adults was scant and requires further longitudinal studies.
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Affiliation(s)
- Emily Lim
- Department of Gerontology, University of Massachusetts Boston, Wheatley Hall, 100 William T. Morrissey Boulevard, Boston, MA, 02125, USA
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
| | - Natalia Nielsen
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
| | - Lucienne Lapane
- Boston University, School of Social Work, 264 Bay State Road, Boston, MA, 02215, USA
| | - Adrita Barooah
- Department of Gerontology, University of Massachusetts Boston, Wheatley Hall, 100 William T. Morrissey Boulevard, Boston, MA, 02125, USA
| | - Shu Xu
- Department of Gerontology, University of Massachusetts Boston, Wheatley Hall, 100 William T. Morrissey Boulevard, Boston, MA, 02125, USA
| | - Shan Qu
- Department of Gerontology, University of Massachusetts Boston, Wheatley Hall, 100 William T. Morrissey Boulevard, Boston, MA, 02125, USA
| | - Emily McPhillips
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
| | - Catherine E. Dube
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
| | - Kate Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
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30
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Long EM. Promoting Connection in the Faith Community Through Letter Writing. J Christ Nurs 2023; 40:260-265. [PMID: 37653657 DOI: 10.1097/cnj.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
ABSTRACT Faith community nurses can reduce loneliness and provide connection for homebound members of faith communities through promotion of letter writing. Undergraduate nursing students who were matched with members of their own faith community wrote letters to older adults for 10 weeks as a community service-learning project. Data from the UCLA Loneliness Scale pre- and post-intervention showed reduced loneliness and greater connection among recipients of the letters.
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Affiliation(s)
- Elizabeth M Long
- Elizabeth M. Long, DNP, APRN, GNP-BC, CNS, CNE, is an associate professor of nursing at Lamar University, a gerontological nurse practitioner, faith community nurse, and a Hartford Distinguished Educator in Gerontological Nursing
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31
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Khaliq KA, Noakes C, Kemp AH, Thompson C. Evaluating the performance of wearable devices for contact tracing in care home environments. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:468-479. [PMID: 37540215 DOI: 10.1080/15459624.2023.2241522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
COVID-19 has had a devastating impact worldwide, including in care homes where there have been substantial numbers of cases among a very vulnerable population. A key mechanism for managing exposure to the virus and targeting interventions is contact tracing. Unfortunately, environments such as care homes that were most catastrophically impacted by COVID-19 are also those least amenable to traditional contact tracing. A promising alternative to recall and smartphone-based contact tracing approaches is the use of discrete wearable devices that exploit Bluetooth Low Energy (BLE) and Long-Range Wide Area Network (LoRaWAN) technologies. However, the real-world performance of these devices in the context of contact tracing is uncertain. A series of experiments were conducted to evaluate the performance of a wearables system that is based on BLE and LoRaWAN technologies. In each experiment, the number of successful contacts was recorded and the physical distance between two contacts was compared to a calculated distance using the Received Signal Strength Indication (RSSI) to determine the precision, error rate, and duration of proximity. The overall average system contact detection success rate was measured as 75.5%; when wearables were used as per the manufacturer's guidelines the contact detection success rate increased to 81.5%, but when obstructed by everyday objects such as clothing or inside a bag the contact detection success rate was only 64.2%. The calculated distance using RSSI was close to the physical distance in the absence of obstacles. However, in the presence of typical obstacles found in care home settings, the reliability of detection decreased, and the calculated distance usually appeared far from the actual contact point. The results suggest that under real-world conditions there may be a large proportion of contacts that are underestimated or undetected.
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Affiliation(s)
| | | | - Andrew H Kemp
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Carl Thompson
- School of HealthCare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Kortes-Miller K, Natale M, Wilson K, Stinchcombe A. The Perpetual Pivot: Understanding Care Partner Experiences in Ontario Long-Term Care Homes during the COVID-19 Pandemic. Geriatrics (Basel) 2023; 8:90. [PMID: 37736890 PMCID: PMC10514792 DOI: 10.3390/geriatrics8050090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
Long-term care homes (LTCHs) were impacted during the COVID-19 pandemic. With their ever-changing conditions and restrictions, care partners' roles in LTCHs changed drastically. In this cross-sectional study, an electronic survey was used to examine the experiences of care part-ners who were caring for one or more adults in an Ontario LTCH during the pandemic. The survey was circulated through social media (convenience sample) which produced a convenience sample of 81 caregiver participants. Visit characteristics and a comparison in the quality of care in LTCHs was analyzed before the pandemic as well as during the most restrictive times. Visitation lengths and frequencies, other sources of communication such as phone and video calls, and various types of care provided by caregivers such as personal grooming and personal care all decreased significantly during the pandemic. Care partners also reported that the health of their care recipients decreased significantly during restrictive visitation times. Through thematic analysis, we identified three themes: restrictions and changing LTCH conditions created (1) social isolation and an erosion of connection, (2) a communication breakdown, and (3) a lack of person-centered care. Findings from this research can promote the health and wellbeing of residents and care partners within LTCHs.
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Affiliation(s)
| | - Maïa Natale
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Arne Stinchcombe
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Landeweer E, Hovenga N, Noten S, Vinckers F, Witte JD, Stoop A, Zuidema S. Moral lessons from residents, close relatives and volunteers about the COVID-19 restrictions in Dutch and Flemish nursing homes. Philos Ethics Humanit Med 2023; 18:12. [PMID: 37670362 PMCID: PMC10481572 DOI: 10.1186/s13010-023-00140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND During the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As 'safety' prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding the restrictions in retrospect, and what moral lessons they considered important. METHODS We conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design. RESULTS Critical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions. DISCUSSION Comparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives.
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Affiliation(s)
- Elleke Landeweer
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands.
| | - Nina Hovenga
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands
| | - Suzie Noten
- TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Floor Vinckers
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands
| | - Jasper de Witte
- HIVA- Research Institute for Work and Society, KU Leuven, P.O. Box 5300, 3000, Leuven, Belgium
| | - Annerieke Stoop
- TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Sytse Zuidema
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands
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Bird MJ, Li G, MacNeil A, Jiang Y, de Groh M, Fuller-Thomson E. Pandemic-Induced Depression Among Older Adults with a History of Cancer During the COVID-19 Pandemic: Findings from the Canadian Longitudinal Study on Aging. Cancer Manag Res 2023; 15:937-955. [PMID: 37700810 PMCID: PMC10493151 DOI: 10.2147/cmar.s421675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose The objectives of this study were to identify the prevalence of, and factors associated with, incident and recurrent depression in a sample of older adults with a history of cancer during the COVID-19 pandemic. Materials and Methods Data were drawn from four waves of the Canadian Longitudinal Study on Aging Comprehensive Cohort (n=2486 with cancer). The outcome of interest was a positive screen for depression based on the CES-D-10 during the autumn of 2020. Results Among older adults with cancer and no pre-pandemic history of depression (n=1765), 1 in 8 developed first onset depression during the pandemic. Among respondents with cancer and a history of depression (n=721), 1 in 2 experienced a recurrence of depression. The risk of both incident and recurrent depression was higher among those who were lonely, those with functional limitations, and those who experienced an increase in family conflict during the pandemic. The risk of incident depression only was higher among older women, those who did not engage in church or religious activities, those who experienced a loss of income during the pandemic, and those who became ill or had a loved one become ill or die during the pandemic. The risk of recurrent depression only was higher among those who felt isolated from others and those whose income did not satisfy their basic needs. Conclusion Health care providers should continue to screen and provide mental health support to their cancer patients and those with a lifetime history of cancer, with consideration for those with the aforementioned vulnerabilities.
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Affiliation(s)
- Meghan J Bird
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
| | - Grace Li
- Department of Sociology, University of Victoria, Victoria, BC, Canada
| | - Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
| | - Ying Jiang
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Margaret de Groh
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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35
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Quan M, Wang X, Gong M, Wang Q, Li Y, Jia J. Post-COVID cognitive dysfunction: current status and research recommendations for high risk population. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100836. [PMID: 37457901 PMCID: PMC10344681 DOI: 10.1016/j.lanwpc.2023.100836] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/13/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Post-COVID cognitive dysfunction (PCCD) is a condition in which patients with a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, usually three months from the onset, exhibit subsequent cognitive impairment in various cognitive domains, and cannot be explained by an alternative diagnosis. While our knowledge of the risk factors and management strategy of PCCD is still incomplete, it is necessary to integrate current epidemiology, diagnosis and treatment evidence, and form consensus criteria to better understand this disease to improve disease management. Identifying the risk factors and vulnerable population of PCCD and providing reliable strategies for effective prevention and management is urgently needed. In this paper, we reviewed epidemiology, diagnostic markers, risk factors and available treatments on the disease, formed research recommendation framework for vulnerable population, under the background of post-COVID period.
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Affiliation(s)
- Meina Quan
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
| | - Xuechu Wang
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Min Gong
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Qi Wang
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
| | - Yan Li
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Jianping Jia
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
- Beijing Key Laboratory of Geriatric Cognitive Disorders, China
- Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, China
- Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
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Lapane KL, Lim E, Mack DS, Hargraves JL, Cosenza C, Dubé CE. Rising to the Occasion: A National Nursing Home Study Documenting Attempts to Address Social Isolation During the COVID-19 Pandemic. J Am Med Dir Assoc 2023; 24:1127-1132.e6. [PMID: 37355245 PMCID: PMC10227205 DOI: 10.1016/j.jamda.2023.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES COVID-19-related policies introduced extraordinary social disruption in nursing homes. In response, nursing facilities implemented strategies to alleviate their residents' loneliness. This study sought to describe interventions nursing homes used, document the perceived effectiveness of efforts, and determine barriers to implementing strategies to mitigate social isolation and loneliness. DESIGN National survey of nursing homes sampled in strata defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5). SETTINGS AND PARTICIPANTS US Nursing Home Directors of Nursing/Administrators (n = 1676). METHODS The survey was conducted between February and May 2022 (response rate: 30%; n = 504, weighted n = 14,506). Weighted analyses provided nationally representative results. RESULTS One-third were extremely concerned about their home's ability to meet residents' medical and social needs during COVID-19 before vaccines were available and 13% after vaccines. Nearly all reported trying to mitigate residents' social isolation during the pandemic. Efforts tried, and perceived as most useful, included using technology (tablets, phones, emails), assigning staff as a family contact, and more staff time with residents. Most frequently cited barriers to implementation were related to staffing issues. CONCLUSIONS AND IMPLICATIONS Despite multiple challenges, nearly all nursing homes tried to implement many different approaches to address residents' social needs, with some (eg, having an assigned family contact, use of tablets and phones) perceived as more useful than others. Staffing issues presented barriers for addressing the social needs of nursing home residents. Many strategies for addressing social isolation placed more demands on a workforce already stretched to the limit. While concerns about resident social isolation reduced after vaccine availability, administrators remained extremely concerned about staff burnout and mental health.
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Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Emily Lim
- Department of Gerontology, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Deborah S Mack
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - J Lee Hargraves
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA; Center for Survey Research, University of Massachusetts Boston, Boston, MA, USA
| | - Carol Cosenza
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Catherine E Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Harding E, Rossi-Harries S, Gerritzen EV, Zimmerman N, Hoare Z, Proctor D, Brotherhood E, Crutch S, Suárez-González A. "I felt like I had been put on the shelf and forgotten about" - lasting lessons about the impact of COVID-19 on people affected by rarer dementias. BMC Geriatr 2023; 23:392. [PMID: 37370011 DOI: 10.1186/s12877-023-03992-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/23/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The public health measures imposed in many countries to contain the spread of COVID-19 resulted in significant suspensions in the provision of support and care for people with dementia. The negative effects of these measures have been extensively reported. However, little is known about the specific impact on people with young onset, non-memory-led and inherited dementias. This group may have experienced different challenges compared to those with late onset dementia given their non-memory phenotypes and younger age. We explored the impact of the first COVID-19 lockdown on people living with familial Alzheimer's disease, behavioural variant frontotemporal dementia, familial frontotemporal dementia, dementia with Lewy bodies, posterior cortical atrophy and primary progressive aphasia and their carers in the UK and their self-reported strategies for coping. METHODS This was a mixed methods study. An online survey was administered to people with dementia and family carers recruited via Rare Dementia Support. Free-text responses were analysed using framework analysis to identify key issues and themes. RESULTS 184 carers and 24 people with dementia completed the survey. Overall, people with dementia experienced worsening of cognitive symptoms (70%), ability to do things (62%), well-being (57%) and changes to medication (26%) during lockdown. Carers reported a reduction in the support they received (55%) which impacted their own mental health negatively. Qualitative analysis of free-text responses shed light on how the disruption to routines, changes to roles and responsibilities, and widespread disconnection from friends, family and health and social care support varied according to phenotype. These impacts were exacerbated by a more general sense that precious time was being lost, given the progressive nature of dementia. Despite significant challenges, respondents demonstrated resilience and resourcefulness in reporting unexpected positives and strategies for adapting to confinement. CONCLUSIONS This study has highlighted the specific impacts of the COVID-19 restrictions on people with young onset, non-memory-led and inherited dementias, including behavioural variant frontotemporal dementia, primary progressive aphasia and posterior cortical atrophy, and their carers. The specific challenges faced according to diagnosis and the self-reported strategies speak to the importance of - and may inform the development of - tailored support for these underrepresented groups more generally.
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Affiliation(s)
- Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Sam Rossi-Harries
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Esther Vera Gerritzen
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nikki Zimmerman
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Zoe Hoare
- NWORTH Clinical Trials Unit, School of Health Sciences, Bangor University, Bangor, UK
| | - Danielle Proctor
- Department of Clinical, Educational, and Health Psychology, UCL Division of Psychology and Language Sciences, UCL, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Sebastian Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK.
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Malara A, Noale M, Trevisan C, Abbatecola AM, Borselli G, Cafariello C, Gareri P, Fumagalli S, Mossello E, Volpato S, Monzani F, Coin A, Okoye C, Bellelli G, Del Signore S, Zia G, Antonelli Incalzi R, Palmieri A, Fedele G, Onder G. Efficacy of COVID-19 control measures on post-vaccination outbreak in Italian Long Term Care Facilities: implications for policies. Front Public Health 2023; 11:1091974. [PMID: 37346108 PMCID: PMC10280634 DOI: 10.3389/fpubh.2023.1091974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
Background Numerous individual and organizational factors can influence the spread of SARS-CoV-2 infection in Long Term Care Facilities (LTCFs). A range of outbreak control measures are still implemented in most facilities involving administrations, staff, residents and their families. This study aims to evaluate which measure could influence the transmission of SARS-CoV-2 infection among residents during the period March 2021-June 2022. Methods We enrolled 3,272 residents aged ≥60 years. The outbreak control measures adopted to prevent or manage the infection included entry regulations, contact-regulating procedures, and virological surveillance of residents and staff. The association between LTCFs' and participants' characteristics with new cases of COVID-19 infections was analyzed using multilevel logistic regression models. Results In 33.8% of the facilities 261 cases of SARS-CoV-2 infection were reported. Among participant characteristics, gender and age were not associated with SARS-CoV-2 infection, while having received the vaccine booster dose was protective against infection [Odds Ratio (OR) = 0.34, 95% Confidence Interval (CI) 0.12-0.99, p = 0.048]. In addition, the implementation of protected areas for family visits was associated with a significant reduction of the probability of infections (OR = 0.18, 95% CI 0.03-0.98, p = 0.047). Overall, about 66% of the variability in the probability of SARS-CoV-2 infection during the observational period may be due to facility structure characteristics and 34% to the participant characteristics. Conclusions These data showed that vaccination booster doses and family visit restriction-control are still needed to make the LTCFs safer against SARS-CoV-2 infection.
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Affiliation(s)
- Alba Malara
- Associazione Nazionale Strutture Territoriali-Humanitas Foundation, Rome, Italy
| | - Marianna Noale
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Caterina Trevisan
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Department of Medicine, University of Padua, Padua, Italy
| | | | - Gilda Borselli
- Italian Society of Gerontology and Geriatrics, Florence, Italy
| | | | - Pietro Gareri
- Center for Cognitive Disorders and Dementia (CDCD) Catanzaro Lido – ASP Catanzaro, Catanzaro, Italy
| | - Stefano Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence and Division of Geriatric and Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Enrico Mossello
- Department of Experimental and Clinical Medicine, University of Florence and Division of Geriatric and Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca and Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | | | | | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Annapina Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Giorgio Fedele
- Department of Infectious Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Universita' Cattolica Sacro Cuore, Rome, Italy
- Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Dugdale LS, Esbensen KL, Sulmasy LS. Ethical Guidance on Family Caregiving, Support, and Visitation in Hospitals and Residential Health Care Facilities, Including During Public Health Emergencies: an American College of Physicians Position Paper. J Gen Intern Med 2023; 38:1986-1993. [PMID: 36940066 PMCID: PMC10027272 DOI: 10.1007/s11606-023-08070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/27/2023] [Indexed: 03/21/2023]
Abstract
Public health emergencies create challenges for the accommodation of visitors to hospitals and other care facilities. To mitigate the spread of COVID-19 early in the pandemic, health care institutions implemented severe visitor restrictions, many remaining in place more than 2 years, producing serious unintended harms. Visitor restrictions have been associated with social isolation and loneliness, worse physical and mental health outcomes, impaired or delayed decision-making, and dying alone. Patients with disabilities, communication challenges, and cognitive or psychiatric impairments are particularly vulnerable without caregiver presence. This paper critically examines the justifications for, and harms imposed by, visitor restrictions during the COVID-19 pandemic and offers ethical guidance on family caregiving, support, and visitation during public health emergencies. Visitation policies must be guided by ethical principles; incorporate the best available scientific evidence; recognize the invaluable roles of caregivers and loved ones; and involve relevant stakeholders, including physicians, who have an ethical duty to advocate for patients and families during public health crises. Visitor policies should be promptly revised as new evidence emerges regarding benefits and risks in order to prevent avoidable harms.
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Affiliation(s)
- Lydia S Dugdale
- Columbia University Vagelos College of Physicians & Surgeons, New York-Presbyterian Hospital, 630 West 168Th Street, New York, NY, 10032, USA
| | - Kari L Esbensen
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Lois Snyder Sulmasy
- American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA, 19106, USA.
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Hoben M, Dymchuk E, Corbett K, Devkota R, Shrestha S, Lam J, Banerjee S, Chamberlain SA, Cummings GG, Doupe MB, Duan Y, Keefe J, O'Rourke HM, Saeidzadeh S, Song Y, Estabrooks CA. Factors Associated With the Quality of Life of Nursing Home Residents During the COVID-19 Pandemic: A Cross-Sectional Study. J Am Med Dir Assoc 2023:S1525-8610(23)00325-0. [PMID: 37150208 PMCID: PMC10076504 DOI: 10.1016/j.jamda.2023.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Quality of life (QoL) of nursing home (NH) residents is critical, yet understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, lack of access to geriatric professionals, and care aide burnout were associated with NH residents' QoL. DESIGN Cross-sectional study (July to December 2021). SETTING AND PARTICIPANTS We purposefully selected 9 NHs in Alberta, Canada, based on their COVID-19 exposure (no or minor/short outbreaks vs repeated or extensive outbreaks). We included data for 689 residents from 18 care units. METHODS We used the DEMQOL-CH to assess resident QoL through video-based care aide interviews. Independent variables included a COVID-19 outbreak in the NH in the past 2 weeks (health authority records), care unit-levels of care aide burnout (9-item short-form Maslach Burnout Inventory), and resident access to geriatric professionals (validated facility survey). We ran mixed-effects regression models, adjusted for facility and care unit (validated surveys), and resident covariates (Resident Assessment Instrument-Minimum Data Set 2.0). RESULTS Recent COVID-19 outbreaks (β = 0.189; 95% CI: 0.058-0.320), higher proportions of emotionally exhausted care aides on a care unit (β = 0.681; 95% CI: 0.246-1.115), and lack of access to geriatric professionals (β = 0.216; 95% CI: 0.003-0.428) were significantly associated with poorer resident QoL. CONCLUSIONS AND IMPLICATIONS Policies aimed at reducing infection outbreaks, better supporting staff, and increasing access to specialist providers may help to mitigate how COVID-19 has negatively affected NH resident QoL.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada; College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
| | - Emily Dymchuk
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Kyle Corbett
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Rashmi Devkota
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Shovana Shrestha
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jenny Lam
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, England, UK
| | | | - Greta G Cummings
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Malcolm B Doupe
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yinfei Duan
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Faculty of Arts, Mount Saint Vincent University, Halifax, NS, Canada
| | - Hannah M O'Rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | - Yuting Song
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada; School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Carole A Estabrooks
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Long-Term Care and the COVID-19 Pandemic: Lessons Learned. Nurs Clin North Am 2023; 58:35-48. [PMID: 36731958 PMCID: PMC9606037 DOI: 10.1016/j.cnur.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
US nursing homes and other long-term care (LTC) communities such as assisted living and adult day care services have been disproportionally affected by COVID-19. Nurses and health care workers provided care and services despite health concerns for themselves and family members. Nurses on the frontline were called to act with extraordinary tenacity, skill, flexibility, and creativity to prevent infection; prevent complications; and optimize function, health, and well-being. The purpose of this article is to provide an overview of the challenges posed by the COVID-19 pandemic and the strategies prioritized and implemented by nurse and interdisciplinary colleagues in LTC settings.
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Angevaare MJ, Joling KJ, Smalbrugge M, Choi H, Twisk JWR, Hertogh CMPM, van Hout HPJ. Psychological Resilience in Older Residents of Long-Term Care Facilities: Occurrence and Associated Factors. J Am Med Dir Assoc 2023; 24:382-389.e4. [PMID: 36592940 DOI: 10.1016/j.jamda.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/31/2022] [Accepted: 12/03/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The researchers aimed to (1) explore the occurrence of psychological resilience in the face of a major life stressor and conflict in older residents of long-term care facilities (LTCFs), and (2) identify factors associated with resilience in this population. DESIGN Longitudinal cohort study using the Dutch InterRAI-LTCF cohort. SETTING AND PARTICIPANTS Older residents (≥60 years old) of 21 LTCFs in the Netherlands. METHODS The researchers selected 2 samples of residents who had at least 2 assessments surrounding (1) an incident major life stressor, or (2) incident conflict with other resident or staff. A resilient outcome was operationalized as not having clinically meaningful mood symptoms at the post-stressor assessment and equal or fewer mood symptoms at the post-stressor relative to the pre-stressor assessment. The researchers used 2 resilience outcomes per stressor: 1 based on observer-reported mood symptoms and 1 based on self-reported mood symptoms. The most important factors from among 21 potential resilience factors for each of the 4 operationalizations of resilience were identified using a backward selection procedure with 2-level generalized estimating equations analyses. RESULTS Forty-eight percent and 50% of residents were resilient in the face of a major life stressor, based on observer-reported (n = 248) and self-reported (n = 211) mood, respectively. In the face of conflict, 26% and 51% of the residents demonstrated resilience, based on the observer-reported (n = 246) and self-reported (n = 183) mood, respectively. Better cognitive functioning, a strong and supportive relationship with family, participation in social activities, and better self-reported health were most strongly associated with resilience in the face of a major life stressor. Better communicative functioning, absence of psychiatric diagnoses, a strong and supportive relationship with family, not being lonely, social engagement, and not reminiscing about life were most strongly associated with resilience in the face of conflict. CONCLUSIONS AND IMPLICATIONS Factors with a social aspect appear to be particularly important to psychological resilience in older LTCF residents, and provide a potential target for intervention in the LTCF setting.
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Affiliation(s)
- Milou J Angevaare
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hyoungshim Choi
- Department of Nursing, Hansei University, Gunpo, Gyeonggi, South Korea
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hein P J van Hout
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Coe AB, Montoya A, Chang CH, Park PS, Bynum JP, Shireman TI, Zhang T, McCreedy EM, Gerlach LB. Behavioral symptoms, depression symptoms, and medication use in Michigan nursing home residents with dementia during COVID-19. J Am Geriatr Soc 2023; 71:414-422. [PMID: 36349415 PMCID: PMC9877723 DOI: 10.1111/jgs.18116] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/21/2022] [Accepted: 10/09/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The COVID-19 pandemic significantly disrupted nursing home (NH) care, including visitation restrictions, reduced staffing levels, and changes in routine care. These challenges may have led to increased behavioral symptoms, depression symptoms, and central nervous system (CNS)-active medication use among long-stay NH residents with dementia. METHODS We conducted a retrospective, cross-sectional study including Michigan long-stay (≥100 days) NH residents aged ≥65 with dementia based on Minimum Data Set (MDS) assessments from January 1, 2018 to June 30, 2021. Residents with schizophrenia, Tourette syndrome, or Huntington's disease were excluded. Outcomes were the monthly prevalence of behavioral symptoms (i.e., Agitated Reactive Behavior Scale ≥ 1), depression symptoms (i.e., Patient Health Questionnaire [PHQ]-9 ≥ 10, reflecting at least moderate depression), and CNS-active medication use (e.g., antipsychotics). Demographic, clinical, and facility characteristics were included. Using an interrupted time series design, we compared outcomes over two periods: Period 1: January 1, 2018-February 28, 2020 (pre-COVID-19) and Period 2: March 1, 2020-June 30, 2021 (during COVID-19). RESULTS We included 37,427 Michigan long-stay NH residents with dementia. The majority were female, 80 years or older, White, and resided in a for-profit NH facility. The percent of NH residents with moderate depression symptoms increased during COVID-19 compared to pre-COVID-19 (4.0% vs 2.9%, slope change [SC] = 0.03, p < 0.05). Antidepressant, antianxiety, antipsychotic and opioid use increased during COVID-19 compared to pre-COVID-19 (SC = 0.41, p < 0.001, SC = 0.17, p < 0.001, SC = 0.07, p < 0.05, and SC = 0.24, p < 0.001, respectively). No significant changes in hypnotic use or behavioral symptoms were observed. CONCLUSIONS Michigan long-stay NH residents with dementia had a higher prevalence of depression symptoms and CNS active-medication use during the COVID-19 pandemic than before. During periods of increased isolation, facility-level policies to regularly assess depression symptoms and appropriate CNS-active medication use are warranted.
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Affiliation(s)
- Antoinette B. Coe
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Ana Montoya
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Chiang-Hua Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Pil S. Park
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Julie P.W. Bynum
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Theresa I. Shireman
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence Rhode Island
| | - Tingting Zhang
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence Rhode Island
| | - Ellen M. McCreedy
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence Rhode Island
| | - Lauren B. Gerlach
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Zhu X, He M, Dong Y, Zhang S, Fang S, Wang W, Zhang M, Sun J. How tablets/applications enhance social connections and social support in people with dementia: A qualitative systematic review. Int J Ment Health Nurs 2023; 32:727-743. [PMID: 36715170 DOI: 10.1111/inm.13112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/31/2023]
Abstract
The 2020 Lancet issue identified social isolation as one of 12 modifiable risk factors for dementia and revealed that enhanced social connections and social support can effectively reduce the incidence of social isolation. During the COVID-19 pandemic, technology attracted an increasing amount of attention, and it is necessary to synthesize ideas from existing evidence. First, we explored how people with dementia experienced changes in social connection and social support due to tablet/app use. Second, we explored the attitudes of people with dementia towards tablets and mobile applications. Third, we explored the feasibility of using tablets and mobile applications to enhance social connection and social support among people with dementia. We systematically searched the PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, WanFang, and VIP databases. Two reviewers independently screened the titles and abstracts of studies, extracted the data and performed critical appraisals of each included study. The data synthesis was conducted using thematic analysis. A total of nine studies were included. Eight studies used mobile applications via tablets, and one study collected textual data from Twitter for analysis. Four themes were synthesized: (1) change from the perspective of caregivers; (2) growth of nonsingle aspects; (3) emotional feeling of belonging; and (4) feasibility of using digital technology. Tablet- and mobile application-based interventions can enhance both online and offline social connections and provide multiple types of social support among people with dementia. People with dementia have positive attitudes towards tablets and mobile applications. Overall, it is feasible for people with dementia to use technology.
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Affiliation(s)
| | - Meng He
- School of Nursing, Jilin University, Jilin, China
| | - Yueyang Dong
- School of Nursing, Jilin University, Jilin, China
| | - Shuang Zhang
- School of Nursing, Jilin University, Jilin, China
| | - Shuyan Fang
- School of Nursing, Jilin University, Jilin, China
| | - Wenxia Wang
- School of Nursing, Jilin University, Jilin, China
| | | | - Jiao Sun
- School of Nursing, Jilin University, Jilin, China
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Zhang J, Yu Y, Petrovic M, Pei X, Tian QB, Zhang L, Zhang WH. Impact of the COVID-19 pandemic and corresponding control measures on long-term care facilities: a systematic review and meta-analysis. Age Ageing 2023; 52:6987654. [PMID: 36668818 DOI: 10.1093/ageing/afac308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/04/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. OBJECTIVE To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff. METHOD We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate. RESULTS We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ~ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ~ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents' hospitalisation rate to be 29.09% (95%CI: 25.73 ~ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ~ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ~ 17.30%). Significant publication biases were observed in the residents' case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents. CONCLUSION SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.
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Affiliation(s)
- Jun Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.,The Research Center for Medical Sociology, Tsinghua University, 100084 Beijing, China
| | - Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Xiaomei Pei
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 050017 Shijiazhuang, Hebei, China
| | - Qing-Bao Tian
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, 710061 Xi'an, Shaanxi, China
| | - Lei Zhang
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne 3053, Australia.,Central Clinical School, Faculty of Medicine, Monash University, Melbourne 3800, Australia.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 450001 Zhengzhou, Henan, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.,School of Public Health, Université libre de Bruxelles (ULB), Bruxelles 1070, Belgium
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Wright PJ, Raynor PA, Bowers D, Combs EM, Corbett CF, Hardy H, Patel K. Leveraging digital technology for social connectedness among adults with chronic conditions: A systematic review. Digit Health 2023; 9:20552076231204746. [PMID: 37799504 PMCID: PMC10548813 DOI: 10.1177/20552076231204746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose To review the evidence about the impact of digital technology on social connectedness among adults with one or more chronic health conditions. Methods PubMed, Embase, Social Sciences, CINAHL, and Compendex were systematically searched for full-text, peer-reviewed empirical evidence published between 2012 and 2023 and reported using the PRISMA flow diagram. Articles were critically appraised applying the Joanna Briggs Institute checklists. Specific data were extracted based on the framework for social identity and technology approaches for health outcomes and then analyzed and synthesized. Results Thirty-four studies met study criteria. Evidence showed heterogeneity among research methodology, chronic health conditions, digital technology, and health outcomes. Technology use was influenced by factors such as usability, anonymity, availability, and control. More advanced digital technologies require higher digital literacy and improved accessibility features/modifications. Social support was the most measured aspect of social connectedness. The emotional and informational forms of social support were most reported; instrumental support was the least likely to be delivered. Self-efficacy for using technology was considered in seven articles. Sixteen articles reported health outcomes: 31.2% (n = 5) described mental health outcomes only, 18.8% (n = 3) reported physical health outcomes only, 31.2% (n = 5) detailed both physical and mental health outcomes, whereas 18.8% (n = 3) denoted well-being or quality-of-life outcomes. Most often, health outcomes were positive, with negative outcomes for selected groups also noted. Conclusion Leveraging digital technology to promote social connectedness has the potential to affect positive health outcomes. Further research is needed to better understand the social integration of technology among populations with different contexts and chronic health conditions to enhance and tailor digital interventions.
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Affiliation(s)
- Pamela J Wright
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Phyllis A Raynor
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Dana Bowers
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Elizabeth M Combs
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Cynthia F Corbett
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Hannah Hardy
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
- Department of Public Health, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Khushi Patel
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
- Department of Public Health, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Huang D, Zeng T, Mao J, Zhao M, Wu M. The unmet needs of older adults living in nursing homes in Mainland China: a nation-wide observational study. BMC Geriatr 2022; 22:989. [PMID: 36544110 PMCID: PMC9773463 DOI: 10.1186/s12877-022-03699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The unmet needs of older adults in nursing homes could result in their poor health status physically and psychologically. The aim of this study was to understand the characteristics of unmet needs of older adults residing in nursing homes in China, and to probe into the contributing factors. METHODS In this cross-sectional design, the demographic and health status questionnaire, Modified Barthel Index, the Numerical Rating Scale for pain assessment, Geriatric Depression Scale, Camberwell Assessment of Need for the elderly were employed to survey older adults living in 38 nursing homes in 13 cities in China from July 2017 to June 2018 through a multi-stage, stratified sampling scheme. The Short Portable Mental Status Questionnaire was adopted to exclude participants with severe cognitive impairment. Aside from descriptive analysis, a raft of hierarchical logistic regression models were run by sequentially controlling for the independent variables at 5 levels (demographic characteristics, health status, pain, ADL, and depression), aiming to identify the influencing factors of the unmet needs of the residents. RESULTS The effective sample size involved 2063 older adults (63.4% female versus 36.6% male), with a response rate of 98.5%. The median and inter-quartile range of the total needs and unmet needs of the sample was 3(1, 4) and 0(0, 1) respectively, with 122 older participants having more than 3 unmet needs (high unmet need category) versus 1922 older ones having ≤ 3 unmet needs (low unmet need category). The unmet needs of older adults in nursing homes mainly fell into social domains. Gender, religion, educational background, marital status, living condition before admission, room type, incomes, staffing, number of diseases, pain, Barthel Index, and depression were contributive to unmet needs of older adults in long-term care facilities in the final model that was adjusted for all levels of variables (all p < 0.05). CONCLUSION Understanding the influencing factors of the unmet needs of older adults in long term care provides clues for healthcare professionals to offer better care for this population. System-level support to nursing homes and training of staff are highlighted. Plus, taking measures to beef up social connections for the older adults to meet their social needs was suggested.
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Affiliation(s)
- Deqin Huang
- grid.33199.310000 0004 0368 7223Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030 Wuhan, Hubei Province China ,grid.33199.310000 0004 0368 7223School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, 430030 Wuhan, Hubei Province China
| | - Tieying Zeng
- grid.33199.310000 0004 0368 7223Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030 Wuhan, Hubei Province China
| | - Jing Mao
- grid.33199.310000 0004 0368 7223School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, 430030 Wuhan, Hubei Province China
| | - Meizhen Zhao
- grid.33199.310000 0004 0368 7223Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030 Wuhan, Hubei Province China
| | - Meiliyang Wu
- grid.33199.310000 0004 0368 7223Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030 Wuhan, Hubei Province China
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Community Initiated Care: A blue-print for the practical realization of contextual behavioral science. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Long EM. The effect of letter writing on a long-term care resident with loneliness. Geriatr Nurs 2022; 50:260-261. [PMID: 36446660 PMCID: PMC9700208 DOI: 10.1016/j.gerinurse.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Older adults living in long term care (LTC) facilities may experience increased isolation and loneliness. This was compounded with the Coronavirus Disease 2019 (COVID-19) pandemic. Loneliness and isolation increase the risk for physical, psychological, and social decline. This case report discusses the effect of a letter writing initiative on feelings of loneliness and connection in a long-term care resident. Personalized care is the standard in the long-term care setting and letter writing between two people can contribute to personalized meaningful care as evidenced by the example provided. Further research is needed to explore social connection and loneliness and methods to combat these issues with a personalized approach for different populations within LTC facilities.
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Kumar M, Muhammad T, Dwivedi LK. Assessing the role of depressive symptoms in the association between social engagement and cognitive functioning among older adults: analysis of cross-sectional data from the Longitudinal Aging Study in India (LASI). BMJ Open 2022; 12:e063336. [PMID: 36202587 PMCID: PMC9540840 DOI: 10.1136/bmjopen-2022-063336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The present study aimed to examine the confounding effects of depressive symptoms and the role of gender in the association between social engagement and cognitive functioning among older Indian adults. DESIGN Large-scale cross-sectional survey data were analysed. SETTING AND PARTICIPANTS Data from the Longitudinal Aging Study in India (2017-2019) were used in the analysis. The sample included 23 584 individuals aged 60 years and above (11 403 men and 12 181 women). OUTCOME MEASURES The outcome variable was cognitive functioning, which was based on various measures including immediate and delayed word recall, orientation, executive functioning, arithmetic ability and object naming. Social engagement measure consists of marital status, living arrangement, availability of confidant, and participation in indoor games, and social and cultural functions. The Center for Epidemiological Studies-Depression Scale was used to assess depressive symptoms. RESULTS Significant gender differences in mean cognition scores (men: 25.8, women: 21.1; on a scale of 0-43) were observed. Two-way stratification between social engagement and depressive symptoms was significantly associated with cognitive functioning after controlling for selected explanatory factors. Older men with a low level of social engagements had significantly poor cognitive functioning (β=-1.12; 95% CI: -1.53 to -0.72) compared with men with a high level of social engagements. On the other hand, women with a higher level of social engagement performed poorly on cognitive tests (β=-1.54; 95% CI: -2.11 to -0.98) compared with men with higher social engagements. Three-way stratification between social engagement, gender and depressive symptoms suggests that social engagement's buffering effects are lower in women than in men. The Karlson-Holm-Breen method identified a significant confounding effect of depressive symptoms on the relationship between social engagement and cognitive functioning. CONCLUSION The positive association of social engagement with cognitive functioning was significantly confounded by depressive symptoms, suggesting the need for maintaining social relations that help improve mental health and cognitive functioning among older adults.
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Affiliation(s)
- Manish Kumar
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Laxmi Kant Dwivedi
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
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