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Cullen H, Osborne AK, Kiernan MD, Wilson-Menzfeld G. Facilitating Domestic and Civic-Style Activity in the Later Life of Army Veterans: The Influencing Culture of the Royal Hospital Chelsea. Geriatrics (Basel) 2024; 9:121. [PMID: 39311246 PMCID: PMC11417766 DOI: 10.3390/geriatrics9050121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/11/2024] [Accepted: 09/13/2024] [Indexed: 09/26/2024] Open
Abstract
The Royal Hospital Chelsea has been home to veterans of the British Army since 1692. Opportunities to remain physically active throughout the life course of its residents include participation in numerous hobbies within the quasi-military environment, and in the civic engagement representational role of the Chelsea Pensioner. This study examines the influence the Royal Hospital Chelsea culture has on resident opportunities to remain active. A non-traditional mixed-methods convergent design was used across three participant groups. Staff and established residents engaged in semi-structured qualitative interviews, with established residents and a cohort of new residents completing Quality of Life questionnaires. The findings indicate established Chelsea Pensioners experienced a sense of pride and purpose, elevated social status, and increased life satisfaction as a result of engaging in multiple activities. New Chelsea Pensioners demonstrated a trend towards increased quality of life after six months' residence at the Royal Hospital Chelsea. Further research is required to explore the transferability of similar interventions into other residential establishments.
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Affiliation(s)
- Helen Cullen
- Department of Nursing, Midwifery, and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK; (H.C.); (M.D.K.)
| | - Alison K. Osborne
- Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Matthew D. Kiernan
- Department of Nursing, Midwifery, and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK; (H.C.); (M.D.K.)
| | - Gemma Wilson-Menzfeld
- Department of Nursing, Midwifery, and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK; (H.C.); (M.D.K.)
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Rooney D, Aplin T, Bennett S, Gui DS, Scott T. Exploring occupational therapy practice in Australian residential aged care facilities: A cross-sectional survey. Aust Occup Ther J 2024; 71:578-592. [PMID: 38459851 DOI: 10.1111/1440-1630.12943] [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: 05/07/2023] [Revised: 01/14/2024] [Accepted: 02/17/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Occupational therapy in residential aged care facilities (RACFs) can enhance residents' occupational engagement and wellbeing. However, industry reports suggest that occupational therapists in Australian RACFs have mostly provided physical therapies such as pain management via massage and not addressed residents' occupations. There is limited literature on what constitutes occupational therapists' practice in RACFs to inform policy and practice. The aim of this cross-sectional survey was to explore practice patterns of occupational therapists working in Australian RACFs and influences on their practice. METHODS Occupational therapists working in Australian RACFs were invited from July 2019 to March 2020 to complete a self-report online questionnaire via email and advertisements on industry websites, newsletters, and social media. The questionnaire asked therapists about their caseload, referrals, assessments, and interventions. Data were analysed descriptively and presented as frequencies and percentages. RESULTS A total of 214 occupational therapists completed the survey. Occupational therapists' daily practice largely focussed on pain management; other areas of practice included falls prevention, pressure care, and mobility. The Aged Care Funding Instrument in place at the time of the survey was identified as the leading factor influencing therapists' choice of assessments and interventions. Organisational policies and procedures were also perceived as key factors influencing occupational therapy practice. CONCLUSION This paper highlights the influence of government funding and organisational policies in limiting occupational therapists' scope of practice and their ability to fully address the occupational needs of residents. Occupational therapists and the profession in general should be aware of factors in aged care funding models, and their application, that restrict occupational therapy practice and inhibit residents' function and advocate for change where needed. With the introduction of the Australian National Aged Care Classification funding model replacing Aged Care Funding Instrument, future research should explore potential changes to therapists practice following the implementation of the new funding model.
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Affiliation(s)
- Donna Rooney
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Tammy Aplin
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Dorcas Simin Gui
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Theresa Scott
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
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Davis L, Botting N, Cruice M, Dipper L. Communication support in care homes for older adults: Views and reported practices of speech and language therapists and care home activities staff in the UK. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:1404-1421. [PMID: 38230914 DOI: 10.1111/1460-6984.13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. AIMS To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. METHODS AND PROCEDURES Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID-19. Results were analysed using descriptive statistics and qualitative content analysis. OUTCOMES AND RESULTS A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%-87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%-89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. CONCLUSIONS AND IMPLICATIONS SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. WHAT THIS PAPER ADDS What is already known on the subject There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles.
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Affiliation(s)
- Lydia Davis
- Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Nicola Botting
- Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Madeline Cruice
- Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Lucy Dipper
- Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, UK
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Bradwell HL, Cooper L, Edwards KJ, Baxter R, Tomaz SA, Ritchie J, Gaudl S, Veliz-Reyes A, Ryde GC, Križaj T, Warren A, Chatterjee A, Willis K, Haynes R, Hennessy CH, Whittaker AC, Asthana S, Jones RB. Staff perceptions towards virtual reality-motivated treadmill exercise for care home residents: a qualitative feedback study with key stakeholders and follow-up interview with technology developer. BMJ Open 2023; 13:e073307. [PMID: 37996232 PMCID: PMC10668234 DOI: 10.1136/bmjopen-2023-073307] [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: 03/01/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES Health and care resources are under increasing pressure, partly due to the ageing population. Physical activity supports healthy ageing, but motivating exercise is challenging. We aimed to explore staff perceptions towards a virtual reality (VR) omnidirectional treadmill (MOTUS), aimed at increasing physical activity for older adult care home residents. DESIGN Interactive workshops and qualitative evaluation. SETTINGS Eight interactive workshops were held at six care homes and two university sites across Cornwall, England, from September to November 2021. PARTICIPANTS Forty-four staff participated, including care home, supported living, clinical care and compliance managers, carers, activity coordinators, occupational therapists and physiotherapists. INTERVENTIONS Participants tried the VR treadmill system, followed by focus groups exploring device design, potential usefulness or barriers for care home residents. Focus groups were audio-recorded, transcribed verbatim and thematically analysed. We subsequently conducted a follow-up interview with the technology developer (September 2022) to explore the feedback impact. RESULTS The analysis produced seven key themes: anticipated benefits, acceptability, concerns of use, concerns of negative effects, suitability/unsuitability, improvements and current design. Participants were generally positive towards VR to motivate care home residents' physical activity and noted several potential benefits (increased exercise, stimulation, social interaction and rehabilitation). Despite the reported potential, staff had safety concerns for frail older residents due to their standing position. Participants suggested design improvements to enhance safety, usability and accessibility. Feedback to the designers resulted in the development of a new seated VR treadmill to address concerns about falls while maintaining motivation to exercise. The follow-up developer interview identified significant value in academia-industry collaboration. CONCLUSION The use of VR-motivated exercise holds the potential to increase exercise, encourage reminiscence and promote meaningful activity for care home residents. Staff concerns resulted in a redesigned seated treadmill for those too frail to use the standing version. This novel study demonstrates the importance of stakeholder feedback in product design.
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Affiliation(s)
| | - Leonie Cooper
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | | | - Rory Baxter
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Simone A Tomaz
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - John Ritchie
- Faculty of Arts & Humanities, University of Stirling, Stirling, UK
| | - Swen Gaudl
- Department of Applied IT, University of Gothenburg, Gothenburg, Sweden
| | | | - Gemma C Ryde
- Institute of Cardiovascular and Medical Sciences, University of Stirling, Stirling, UK
| | - Tanja Križaj
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Alison Warren
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | | | - Katharine Willis
- Faculty of Arts, Humanities & Business, University of Plymouth, Plymouth, UK
| | - Richard Haynes
- Faculty of Arts & Humanities, University of Stirling, Stirling, UK
| | | | - Anna C Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Sheena Asthana
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Ray B Jones
- Centre for Health Technology, University of Plymouth, Plymouth, UK
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Kemp CL, Bender AA, Morgan JC, Burgess EO, Epps FR, Hill AM, Perkins MM. Understanding Capacity and Optimizing Meaningful Engagement among Persons Living with Dementia. DEMENTIA 2023; 22:854-874. [PMID: 36913646 PMCID: PMC10789114 DOI: 10.1177/14713012231162713] [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: 03/15/2023]
Abstract
Meaningful engagement is a key dimension of quality of life among persons living with dementia, yet little is known about how to best to promote it. Guided by grounded theory methods, we present analysis of data collected over a 1-year period in four diverse assisted living (AL) communities as part of the study, "Meaningful Engagement and Quality of Life among Assisted Living Residents with Dementia." Our aims are to: (a) learn how meaningful engagement is negotiated among AL residents with dementia and their care partners; and (b) identify how to create these positive encounters. Researchers followed 33 residents and 100 care partners (formal and informal) and used participant observation, resident record review, and semi-structured interviews. Data analysis identified "engagement capacity" as central to the negotiation of meaningful engagement. We conclude that understanding and optimizing the engagement capacities of residents, care partners, care convoys, and settings, are essential to creating and enhancing meaningful engagement among persons living with dementia.
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Affiliation(s)
- Candace L. Kemp
- The Gerontology Institute, Georgia State University, Atlanta, GA
- Department of Sociology, Georgia State University, Atlanta, GA
| | - Alexis A. Bender
- Division of Geriatric & Gerontology, Emory School of Medicine, Atlanta, GA
| | - Jennifer Craft Morgan
- The Gerontology Institute, Georgia State University, Atlanta, GA
- Department of Sociology, Georgia State University, Atlanta, GA
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, GA
| | - Elisabeth O. Burgess
- The Gerontology Institute, Georgia State University, Atlanta, GA
- Department of Sociology, Georgia State University, Atlanta, GA
| | - Fayron R. Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Molly M. Perkins
- Division of Geriatric & Gerontology, Emory School of Medicine, Atlanta, GA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC)
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Möhler R, Calo S, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care. Cochrane Database Syst Rev 2023; 3:CD009812. [PMID: 36930048 PMCID: PMC10010156 DOI: 10.1002/14651858.cd009812.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND People with dementia who are being cared for in long-term care settings are often not engaged in meaningful activities. We wanted to know whether offering them activities which are tailored to their individual interests and preferences could improve their quality of life and reduce agitation. This review updates our earlier review published in 2018. OBJECTIVES ∙ To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in long-term care facilities. ∙ To describe the components of the interventions. ∙ To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, on 15 June 2022. We also performed additional searches in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and the World Health Organization (WHO) ICTRP, to ensure that the search for the review was as up-to-date and as comprehensive as possible. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials offering personally tailored activities. All interventions included an assessment of the participants' present or past preferences for, or interest in, particular activities as a basis for an individual activity plan. Control groups received either usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two authors independently selected studies for inclusion, extracted data and assessed the risk of bias of included studies. Our primary efficacy outcomes were agitation and participant quality of life. Where possible, we pooled data across studies using a random effects model. MAIN RESULTS We identified three new studies, and therefore included 11 studies with 1071 participants in this review update. The mean age of participants was 78 to 88 years and most had moderate or severe dementia. Ten studies were RCTs (three studies randomised clusters to the study groups, six studies randomised individual participants, and one study randomised matched pairs of participants) and one study was a non-randomised clinical trial. Five studies included a control group receiving usual care, five studies an active control group (activities which were not personally tailored) and one study included both types of control group. The duration of follow-up ranged from 10 days to nine months. In nine studies personally tailored activities were delivered directly to the participants. In one study nursing staff, and in another study family members, were trained to deliver the activities. The selection of activities was based on different theoretical models, but the activities delivered did not vary substantially. We judged the risk of selection bias to be high in five studies, the risk of performance bias to be high in five studies and the risk of detection bias to be high in four studies. We found low-certainty evidence that personally tailored activities may slightly reduce agitation (standardised mean difference -0.26, 95% CI -0.53 to 0.01; I² = 50%; 7 studies, 485 participants). We also found low-certainty evidence from one study that was not included in the meta-analysis, indicating that personally tailored activities may make little or no difference to general restlessness, aggression, uncooperative behaviour, very negative and negative verbal behaviour (180 participants). Two studies investigated quality of life by proxy-rating. We found low-certainty evidence that personally tailored activities may result in little to no difference in quality of life in comparison with usual care or an active control group (MD -0.83, 95% CI -3.97 to 2.30; I² = 51%; 2 studies, 177 participants). Self-rated quality of life was only available for a small number of participants from one study, and there was little or no difference between personally tailored activities and usual care on this outcome (MD 0.26, 95% CI -3.04 to 3.56; 42 participants; low-certainty evidence). Two studies assessed adverse effects, but no adverse effects were observed. We are very uncertain about the effects of personally tailored activities on mood and positive affect. For negative affect we found moderate-certainty evidence that there is probably little to no effect of personally tailored activities compared to usual care or activities which are not personalised (standardised mean difference -0.02, 95% CI -0.19 to 0.14; 6 studies, 632 participants). We were not able to undertake meta-analyses for engagement and sleep-related outcomes, and we are very uncertain whether personally tailored activities have any effect on these outcomes. Two studies that investigated the duration of the effects of personally tailored activities indicated that the intervention effects they found persisted only during the period of delivery of the activities. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia in long-term care may slightly reduce agitation. Personally tailored activities may result in little to no difference in quality of life rated by proxies, but we acknowledge concerns about the validity of proxy ratings of quality of life in severe dementia. Personally tailored activities probably have little or no effect on negative affect, and we are uncertain whether they have any effect on positive affect or mood. There was no evidence that interventions were more likely to be effective if based on one theoretical model rather than another. We included three new studies in this updated review, but two studies were pilot trials and included only a small number of participants. Certainty of evidence was predominately very low or low due to several methodological limitations of and inconsistencies between the included studies. Evidence is still limited, and we remain unable to describe optimal activity programmes. Further research should focus on methods for selecting appropriate and meaningful activities for people in different stages of dementia.
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Affiliation(s)
- Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Stella Calo
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Renom
- Department of Geriatrics, Parc de Salut Mar, Barcelona, Spain
| | - Helena Renom
- Physical Medicine and Rehabilitation (MFRHB), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Haunch K, Downs M, Oyebode J. Leading by example: Nursing home staff experiences of what facilitates them to meaningfully engage with residents with advanced dementia. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5805. [PMID: 36040653 PMCID: PMC9541111 DOI: 10.1002/gps.5805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Meaningful connections promote the quality of life of people living with advanced dementia in nursing homes. However, evidence internationally suggests people living with advanced dementia in nursing homes spend the majority of time alone, with little contact with anyone. Frontline care workers are in powerful positions to meaningfully engage with residents, yet research to date has not focused on their experiences. The aim of this study was to explore the experiences of nursing home staff, specifically, what care workers feel enables them to meaningfully engage with residents living with advanced dementia. METHODS/DESIGN Semi-structured interviews were conducted with 21 staff from seven nursing homes. Inductive thematic analysis was used. RESULTS Four themes were important for facilitating care workers to meaningfully engage with residents with advanced dementia: support from managers and nurses, support from experienced care workers, a caring culture and an appropriate physical environment. CONCLUSION Effective leadership was the key thread that ran throughout. It was evident that meaningfully engaging with residents with advanced dementia was hard, particularly for new or inexperienced care workers. Those with experience (of care work and the residents they cared for), as well as those in formal leadership positions played key roles in facilitating care workers to: perceive it was their role to connect, understand, accept and empathise with residents, understand the importance of getting to know residents' and express their own caring attributes. Future research should focus on empirically testing leadership models that promote meaningful engagement.
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8
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Cyarto EV, Dickins M, Meyer C, Lowthian JA. Cycling Without Age: An Australian residential aged care home experience. Australas J Ageing 2022; 41:e249-e256. [PMID: 35864590 PMCID: PMC9546311 DOI: 10.1111/ajag.13114] [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] [Received: 06/03/2021] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 12/03/2022]
Abstract
Objective Cycling Without Age (CWA) involves taking residents on outdoor trishaw (electric bicycle) rides driven by trained ‘pilots’. This study explored the CWA experience from the perspective of residents and family members, staff and volunteer pilots from a residential aged care home in Queensland, Australia. Methods A qualitative descriptive design was used. Interviews were conducted with 21 participants. Transcripts were analysed thematically, with the interview questions determining a priori categories followed by coding of central themes. Results Several themes emerged. For residents, seeing familiar places prompted reminiscences, and being outdoors elicited positive emotions. Family members reported CWA was a novel way to be with their loved one. Enabling residents to have time away from the care home with community contact was rewarding for pilots. Staff noted improvement in residents' mood post‐ride, however, rides needed to be scheduled to fit in with their workflow. Conclusions Cycling Without Age was perceived to offer a unique and meaningful experience, with benefits including sharing stories, being outside, and feeling part of the community.
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Affiliation(s)
- Elizabeth V Cyarto
- Bolton Clarke Research Institute, Bolton Clarke, Brisbane, Queensland, Australia.,Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marissa Dickins
- Bolton Clarke Research Institute, Bolton Clarke, Brisbane, Queensland, Australia.,Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Bolton Clarke, Brisbane, Queensland, Australia.,Centre for Health Communication and Participation, La Trobe University, Melbourne, Victoria, Australia.,Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Judy A Lowthian
- Bolton Clarke Research Institute, Bolton Clarke, Brisbane, Queensland, Australia.,Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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9
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Angelou K, McDonnell C, Low LF, du Toit SHJ. Promoting meaningful engagement for residents living with dementia through intergenerational programs: a pilot study. Aging Ment Health 2022; 27:938-947. [PMID: 35822455 DOI: 10.1080/13607863.2022.2098910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Residents living with dementia in residential aged care facilities (RACFs) have reduced access to, and opportunities for, participation in meaningful activities. This leads to increased social isolation and disengagement. Intergenerational programs aim to overcome these issues. Allied health students piloted a live-intergenerational program (LIP), living onsite at a residential aged care facility (RACF) while volunteering for 30 h a month. The purpose of this study was to explore the impact and practicalities for implementing a LIP in an Australian RACF. METHODS This qualitative descriptive pilot study was undertaken to explore the diverse perspectives of various stakeholders. Qualitative data were collected during group discussions directed by the nominal group technique with live-in-students. Interviews were conducted with staff members, relatives, facility management and volunteers. All qualitative data were analysed thematically. RESULTS Two overarching themes emerged. The first, community of care, indicated how care partners and the care context, organisational support and being a live-in-student supported the sustainability of the program. Live-in-students' accessibility promoted opportunities for occupational and social engagement of residents when staff was less available. The second, a collective based on belonging and shared doing, highlighted the program's potential impact and uncovered the development of a collective based on shared belonging. CONCLUSION The LIP highlighted the potential for new dimensions to person-centred care. The pilot study demonstrated intergenerational contact within aged residential care supported the evolvement of a collective and promoted a social approach for ageing well. Further research is needed to identify the long-term impact of the LIP and explore the feasibility of expanding the program.
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Affiliation(s)
- Kylie Angelou
- Faculty of Medicine and Health (Discipline of Occupational Therapy), The University of Sydney, Sydney, Australia
| | | | - Lee-Fay Low
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sanetta H J du Toit
- Faculty of Medicine and Health (Discipline of Occupational Therapy), The University of Sydney, Sydney, Australia
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10
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Bradwell H, Edwards KJ, Winnington R, Thill S, Allgar V, Jones RB. Exploring the effect of implementing affordable socially assistive pet robots in eight care homes before and during the COVID-19 pandemic: a stratified cluster randomised controlled trial and mixed-method study. JMIR Aging 2022; 5:e38864. [PMID: 35830959 PMCID: PMC9407160 DOI: 10.2196/38864] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/10/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Robot pets may assist in the challenges of supporting an aging population with growing dementia prevalence. Prior work has focused on the impacts of the robot seal Paro on older adult well-being, but recent studies have suggested the good acceptability and implementation feasibility of more affordable devices (Joy for All [JfA] cats and dogs). Objective We aimed to address the limited effectiveness research on JfA devices. Methods We conducted an 8-month, stratified, cluster randomized controlled trial in 8 care homes in Cornwall, United Kingdom. Over 4 months, 4 care homes each received 2 JfA devices (1 cat and 1 dog; intervention group), and 4 homes received care as usual (control group). Psychometrics were collected before and after the intervention to compare the change from baseline to follow-up between the groups. In the final 4 months, all 8 care homes received devices, but only qualitative data were collected owing to COVID-19 and reduced capacity. The primary outcome was neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI] Nursing Home version). Care provider burden was a secondary outcome (occupational disruptiveness NPI subscale), alongside the Challenging Behavior scale, the Holden communication scale, the Campaign to End Loneliness questionnaire, and medication use. Qualitative data were collected through care staff observation calendars and end-of-study interviews to understand use, experience, and impact. We also collected demographic data and assessed dementia severity. In total, 253 residents had robot interaction opportunities, and 83 were consented for direct data collection. Results There was a significant difference in the total change from baseline to follow-up between the intervention and control groups for NPI (P<.001) and occupational disruptiveness (P=.03). Neuropsychiatric symptoms increased in the control group and decreased in the intervention group. No significant difference was seen for communication issues or challenging behavior. For NPI subdomains, there were significant differences from baseline to follow-up in delusions (P=.03), depression (P=.01), anxiety (P=.001), elation (P=.02), and apathy (P=.009), all of which decreased in the intervention group and increased slightly in the control group. The summative impact results suggested that most residents (46/54, 85%) who interacted with robots experienced a positive impact. Those who interacted had significantly higher dementia severity scores (P=.001). The qualitative results suggested good adoption, acceptability, and suitability for subjectively lonely individuals and lack of a novelty effect through sustained use, and demonstrated that the reasons for use were entertainment, anxiety, and agitation. Conclusions Affordable robot pets hold potential for improving the well-being of care home residents and people with dementia, including reducing neuropsychiatric symptoms and occupational disruptiveness. This work suggests no novelty effect and contributes toward understanding robot pet suitability. Moreover, interactions were more common among residents with more moderate/severe dementia and those subjectively lonely. Trial Registration ClinicalTrials.gov NCT04168463; https://www.clinicaltrials.gov/ct2/show/NCT04168463
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Affiliation(s)
- Hannah Bradwell
- Centre for Health Technology, University of Plymouth, University of PlymouthDrake Circus, Plymouth, GB
| | - Katie J Edwards
- Centre for Health Technology, University of Plymouth, University of PlymouthDrake Circus, Plymouth, GB
| | - Rhona Winnington
- Auckland University of Technology, 90 Akoranga Drive, Auckland, NZ
| | - Serge Thill
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, NL
| | - Victoria Allgar
- Centre for Health Technology, University of Plymouth, University of PlymouthDrake Circus, Plymouth, GB
| | - Ray B Jones
- Centre for Health Technology, University of Plymouth, University of PlymouthDrake Circus, Plymouth, GB
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11
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Lee K, Cassidy J, Tang W, Kusek V. Older Adults' Responses to a Meaningful Activity Using Indoor-Based Nature Experiences: Bird Tales. Clin Gerontol 2022; 45:301-311. [PMID: 32799781 DOI: 10.1080/07317115.2020.1808869] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Bird Tales is a meaningful activity that creates indoor-based nature experiences for older adults in residential care. This study examined the impact of Bird Tales by understanding what attributes of birds take on meaning to older adults and piloting the program to assess the psychosocial impact on older adults in an assisted living facility. METHODS We conducted a mixed-methods study. First, we conducted focus groups with older adults. Then we used a cross-over study design with random assignment to examine the impact of the program. Potential benefits of the program were examined using individual interviews and repeated measures on psychosocial questionnaires with a paired samples t-test to compare means from pretest and posttest within the intervention group. RESULTS Findings from the focus group indicate multisensory, spiritual, and therapeutic aspects of birds that hold meaning for older adults. The participants in Bird Tales shared positive experiences with the program by discussing cognitively stimulating activity, interactions with others, connections to the past, and positive perceptions of birds and nature. CONCLUSIONS Findings from our study suggest the potential of Bird Tales as a meaningful activity for older adults in residential care settings. We discuss implications for research as well as practice and present our recommendations. CLINICAL IMPLICATIONS Activities in long-term care should be meaningful to meet the psychological and social needs of older adults. Older adults enjoy and may benefit from indoor-based nature activities.
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Affiliation(s)
- Kathy Lee
- School of Social Work, University of Texas at Arlington
| | | | - Weizhou Tang
- Leonard Davis School of Gerontology, University of Southern California
| | - Venieca Kusek
- School of Social Work, University of Texas at Arlington
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12
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Kielsgaard K, Andersen PT, Horghagen S, Nielsen D, Hansen MH, Kristensen HK. Enhancing engagement in meaningful occupation in a dementia town: A qualitative evaluation of MOED - The meaningful occupational engagement intervention for people with dementia. DEMENTIA 2022; 21:731-750. [PMID: 35021922 DOI: 10.1177/14713012211053986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Engagement in meaningful everyday life occupations is linked to well-being. However, people with dementia are often deprived of engagement. As a response, a Danish Dementia Town was established with the intention of transforming care services to improve opportunities for meaningful engagement. The evidence-based The meaningful occupational engagement intervention for people with dementia (MOED) intervention was developed and implemented in dementia town to enhance meaningful occupational engagement. The purpose of this paper is to evaluate the content, impact and implementation process of MOED. METHOD To evaluate MOED, we applied a program theory-based qualitative approach, building on participant observations and informal conversations with people with dementia (n = 7) and staff (n = 9). Data were analysed from a hermeneutic approach to gain an in-depth understanding of how MOED influenced meaningful occupational engagement and to evaluate the implementation process. FINDINGS The main theme 'Engagement in meaningful occupations - a conditional and fragile process' emerged along with three subthemes: 'Creating an everyday space of meaning: Conditions of the intervention', 'Occupational engagement as an opportunity to blossom: Impact of the intervention' and 'Professional identity, culture and reflections: Contextual barriers to changes to working practice'. Together, the subthemes illustrate how engagement in meaningful occupations arose. However, opportunities to engage in meaningful occupations were fragile, as they depended on various factors within the context. CONCLUSION Engagement in meaningful occupations emerged when MOED was applied in accordance with the program theory, as it seemed to create spaces where people with dementia could engage in meaningful occupations and they could blossom over time. However, MOED was only partially implemented in accordance with the developed program theory, as several contextual barriers influenced the sustainability of the intervention. MOED showed potential to support improvement in dementia care activity programmes to enhance opportunities to engage in meaningful occupations in everyday life for people living with dementia.
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Affiliation(s)
- Kamilla Kielsgaard
- University of Southern Denmark, Department of Rehabilitation, Odense University Hospital and Svendborg Hospital and Center of Clinical Research, Odense, Denmark.,Department of Nursing and Occupational Therapy, UCL University College, Odense, Denmark
| | | | - Sissel Horghagen
- Department of Neuromedicine and Movement Science, 8018NTNU, Trondheim, Norway.,Department of Rehabilitation, University of Southern Denmark, Odense University Hospital and Svendborg Hospital and Center of Clinical Research, Odense, Denmark
| | - Dorthe Nielsen
- Centre for Global Health, 6173University of Southern Denmark, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark.,Migrant Health Clinic, Odense University Hospital, Odense, Denmark
| | - Mette Hartvig Hansen
- Department of Nursing and Occupational Therapy, UCL University College, Odense, Denmark
| | - Hanne Kaae Kristensen
- Department of Rehabilitation, Odense University Hospital and Svendborg Hospital and Center of Clinical Research, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
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13
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Towers AM, Smith N, Allan S, Vadean F, Collins G, Rand S, Bostock J, Ramsbottom H, Forder J, Lanza S, Cassell J. Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background
Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them.
Objectives
The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes.
Design
This was a mixed-methods study.
Setting
The setting was care homes for older adults in England.
Participants
Care home residents participated.
Results
Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%.
Limitations
No care homes rated as inadequate were recruited to the study.
Conclusions
The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents.
Future work
Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Nick Smith
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stephen Allan
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Florin Vadean
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Grace Collins
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | | | | | - Julien Forder
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
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14
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Cruyt E, De Vriendt P, De Letter M, Vlerick P, Calders P, De Pauw R, Oostra K, Rodriguez-Bailón M, Szmalec A, Merchán-Baeza JA, Fernández-Solano AJ, Vidaña-Moya L, Van de Velde D. Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults. BMC Public Health 2021; 21:622. [PMID: 33785029 PMCID: PMC8009071 DOI: 10.1186/s12889-021-10673-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/22/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The spread of COVID-19 has affected people's daily lives, and the lockdown may have led to a disruption of daily activities and a decrease of people's mental health. AIM To identify correlates of adults' mental health during the COVID-19 lockdown in Belgium and to assess the role of meaningful activities in particular. METHODS A cross-sectional web survey for assessing mental health (General Health Questionnaire), resilience (Connor-Davidson Resilience Scale), meaning in activities (Engagement in Meaningful Activities Survey), and demographics was conducted during the first Belgian lockdown between April 24 and May 4, 2020. The lockdown consisted of closing schools, non-essential shops, and recreational settings, employees worked from home or were technically unemployed, and it was forbidden to undertake social activities. Every adult who had access to the internet and lived in Belgium could participate in the survey; respondents were recruited online through social media and e-mails. Hierarchical linear regression was used to identify key correlates. RESULTS Participants (N = 1781) reported low mental health (M = 14.85/36). In total, 42.4% of the variance in mental health could be explained by variables such as gender, having children, living space, marital status, health condition, and resilience (β = -.33). Loss of meaningful activities was strongly related to mental health (β = -.36) and explained 9% incremental variance (R2 change = .092, p < .001) above control variables. CONCLUSIONS The extent of performing meaningful activities during the COVID-19 lockdown in Belgium was positively related to adults' mental health. Insights from this study can be taken into account during future lockdown measures in case of pandemics.
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Affiliation(s)
- Ellen Cruyt
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000, Ghent, Belgium
| | - Patricia De Vriendt
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000, Ghent, Belgium
- Department of Occupational Therapy, Artevelde University College, Ghent, Belgium
- Mental Health Research group, Frailty in Ageing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Miet De Letter
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000, Ghent, Belgium
| | - Peter Vlerick
- Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Ghent University, Ghent, Belgium
| | - Patrick Calders
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000, Ghent, Belgium
| | - Robby De Pauw
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000, Ghent, Belgium
| | - Kristine Oostra
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000, Ghent, Belgium
| | | | - Arnaud Szmalec
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Department of Experimental Psychology, Ghent University, Ghent, Belgium
| | - Jose Antonio Merchán-Baeza
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), 08500, Vic, Spain
| | - Ana Judit Fernández-Solano
- Department of Occupational Therapy. School of Health Sciences, Catholic University of Murcia, Murcia, Spain
| | - Laura Vidaña-Moya
- Research Group GrEUIT, Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, Terrassa, Spain
| | - Dominique Van de Velde
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000, Ghent, Belgium.
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15
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" It Makes You Feel That You Are There": Exploring the Acceptability of Virtual Reality Nature Environments for People with Memory Loss. Geriatrics (Basel) 2021; 6:geriatrics6010027. [PMID: 33809108 PMCID: PMC8005970 DOI: 10.3390/geriatrics6010027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
Aim: To report on the acceptability of virtual reality (VR) nature environments for people with memory loss at memory cafes, and explore the experiences and perceptions of carers and staff. Methods: A qualitative study was conducted between January and March 2019. Ten adults with memory loss, eight carers and six volunteer staff were recruited from two memory cafes, located in Cornwall, UK. There were 19 VR sessions which were audio recorded and all participants were interviewed at the end of the sessions. Framework analysis was used to identify patterns and themes in the data. Results: During the VR experience, participants were engaged to varying degrees, with engagement facilitated by the researcher, and in some cases, with the help of a carer. Participants responded positively to the nature scenes, finding them soothing and evoking memories. The VR experience was positive; many felt immersed in nature and saw it as an opportunity to ‘go somewhere’. However, it was not always positive and for a few, it could be ‘strange’. Participants reflected on their experience of the VR equipment, and volunteer staff and carers also shared their perceptions of VR for people with dementia in long-term care settings. Conclusions: The VR nature experience was an opportunity for people with memory loss to be immersed in nature and offered the potential to enhance their quality of life. Future work should build on lessons learned and continue to work with people with dementia in developing and implementing VR technology in long-term care settings.
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16
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Rand S, Smith N, Jones K, Dargan A, Hogan H. Measuring safety in older adult care homes: a scoping review of the international literature. BMJ Open 2021; 11:e043206. [PMID: 33707269 PMCID: PMC7957135 DOI: 10.1136/bmjopen-2020-043206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Safety is a key concern in older adult care homes. However, it is a less developed concept in older adult care homes than in healthcare settings. As part of study of the collection and application of safety data in the care home sector in England, a scoping review of the international literature was conducted. OBJECTIVES The aim of the review was to identify measures that could be used as indicators of safety for quality monitoring and improvement in older adult residential or nursing care homes. SOURCES OF EVIDENCE Systematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019. ELIGIBILITY CRITERIA Inclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home. A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria. CHARTING METHODS Key information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps. RESULTS AND CONCLUSIONS Systematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019. Inclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home.A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria. Key information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps.The findings indicate that there are a range of available safety measures used for quality monitoring and improvement in older adult care homes. These cover all five domains of safety in the SMMF. However, there are potential gaps. These include user experience, psychological harm related to the care home environment, abusive or neglectful care practice and the processes for integrated learning. Some of these gaps may relate to challenges and feasibility of measurement in the care home context.
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Affiliation(s)
- Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Nick Smith
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Karen Jones
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Alan Dargan
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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17
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Dewitte L, Vandenbulcke M, Schellekens T, Dezutter J. Sources of well-being for older adults with and without dementia in residential care: relations to presence of meaning and life satisfaction. Aging Ment Health 2021; 25:170-178. [PMID: 31729244 DOI: 10.1080/13607863.2019.1691144] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To explore what sources of well-being are rated meaningful by older adults in residential care and how they are related to two important well-being outcomes. METHOD Two cross-sectional questionnaire studies were conducted in a sample of care residents without cognitive disability (n = 329) and with Alzheimer's disease (n = 104). Structural equation modelling was used to test a hypothesized and exploratory model of different sources as predictors of presence of meaning in life (POM) and satisfaction with life (SWL). RESULTS Family and Health were rated most meaningful by residents with and without dementia. In both studies, the hypothesized model showed adequate fit with the data. For cognitively intact residents, Personal Growth, Spirituality/Religion, and Interpersonal Relationships predicted POM, while Family and Leisure predicted SWL. Exploratory testing identified Leisure as a possible additional predictor of POM. For residents with Alzheimer's disease, Personal Growth and Society/Community predicted POM, while Family predicted SWL. CONCLUSION For older adults in residential care, many sources of well-being remain highly meaningful and some are directly related to the experience of meaning and life satisfaction. Both for residents with and without dementia, continued or increased investment in moments that foster personal growth and family relationships might be especially valuable.
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Affiliation(s)
- Laura Dewitte
- KU Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belg ium
| | - Mathieu Vandenbulcke
- Department of Neurosciences, KU Leuven, Leuven, Belgium.,University Psychiatric Centre KU Leuven, Leuven, Belgium
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Social Participation in Long-term Residential Care: Case Studies from Canada, Norway, and Germany. Can J Aging 2020; 40:138-155. [PMID: 32985390 DOI: 10.1017/s0714980820000318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Meaningful social engagement in everyday activities can enhance resident quality of life in nursing homes. In this article, we draw on data collected in a multidisciplinary, international study exploring promising practices in long-term care homes across Canada, Norway, and Germany, to investigate conditions that either allow for or create barriers to residents' social participation. Within a feminist political economy framework using a team-based rapid ethnography approach, observations and in-depth interviews were conducted with management, staff, volunteers, students, families, and residents. We argue that the conditions of work are the conditions of care. Such conditions as care home location, building layout, staffing levels, and work organization, as well as governing regulations, influence if and how residents can and do engage in meaningful everyday social life in/outside the nursing home. The presence of promising conditions that facilitate resident social participation, particularly those promoting flexibility and choice for residents, directly impacts their overall health and well-being.
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Yari M, Lee K, Cassidy J, Chen Z. Transforming Space into Place: A Person-Environment Interchange Approach for Designing an Assisted Living Facility Courtyard. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/26892618.2020.1815923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Mahsa Yari
- HDR, Architecture Inc., Dallas, Texas, USA
| | - Kathy Lee
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Jessica Cassidy
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Zhirui Chen
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
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20
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Affiliation(s)
- Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
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21
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‘It gives you more to life, it's something new every day’: an Interpretative Phenomenological Analysis of wellbeing in older care home residents who keep a personal pet. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x19001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThere is a substantial amount of literature that suggests that animals, and specifically animals kept as pets, can have a positive effect on wellbeing. Research exploring the impact of animals on wellbeing in care homes mainly concerns visiting animals as well as shared communal pets. In light of the lack of research regarding personal pets in care homes, the aim of this study was to explore what the experience of keeping a personal pet in a care home means for residents’ sense of wellbeing. Semi-structured interviews were conducted with seven care home residents who were currently living with their pet in a care home. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Analysis revealed four master themes deemed to be relevant to participants’ wellbeing. these were: ‘sense of self and identity’, ‘responsibility and ownership’, ‘motivation and desire to live’ and ‘feeling content in the care home’. The analysis indicated that living with a personal pet in a care home has the potential to enhance residents’ wellbeing. At the same time, it also found that the benefits of keeping a personal pet may be dependent on specific circumstances, such as the attitudes of staff and fellow residents at the care home. This study indicates that it may be advisable for more care homes to accept personal pets.
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Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents' quality of life in England. Health Qual Life Outcomes 2019; 17:22. [PMID: 30704482 PMCID: PMC6357453 DOI: 10.1186/s12955-019-1093-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/15/2019] [Indexed: 08/19/2023] Open
Abstract
Background The quality of life of people receiving health and social care is an important indicator of service quality, but the relationship between patient experience and outcomes and regulator quality ratings in England is unknown. In 2013, the health and social care regulator in England, the Care Quality Commission (CQC), introduced a new ratings system and by February 2017, all social care services were inspected and awarded new quality ratings (outstanding, good, requires improvement and inadequate). This study aimed to explore whether quality ratings were associated with residents’ quality of life, controlling for confounding variables. Methods We conducted a nested, cross-sectional study, collecting social care-related quality of life (SCRQoL) data for 293 older care home residents in 34 care homes (20 nursing and 14 residential) in the South East of England. CQC ratings and other resident and home-level variables were also collected for the analysis. Multilevel modelling explored whether residents’ social care-related quality of life (SCRQoL) was associated with regulator ratings, controlling for confounding variables. Results Outstanding and good homes were collapsed into one category and compared with homes requiring improvement. Nationally, only 2 % of care homes for older people are rated as inadequate and it was not possible to capture sufficient numbers for the analysis. We recruited one but it was re-inspected during the fieldwork period and its rating changed to requires improvement. The random intercept multilevel model, which accounted for 16.93% of the differences in SCRQoL within homes and 69.80% between, indicated that better SCRQoL was significantly associated with being female, better functioning, no dementia diagnosis, fewer communication difficulties, and living in a care home rated as outstanding/good by CQC. Size of home and registration category were not significant predictors. Conclusions This study found evidence that quality ratings are associated with residents’ SCRQoL. As well as aiming to improve quality and ensure minimum standards, quality ratings have the potential to inform user choice and help the public compare care homes based on quality. Future research to establish the generalisability and replicability of the results is required.
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Affiliation(s)
- Ann-Marie Towers
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK.
| | - Sinead Palmer
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Nick Smith
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Grace Collins
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Stephen Allan
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
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