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Zarling A, Kim J, Russell D, Cutrona C. Increasing Older Adults' Social Connectedness: Development and Implementation of a Web-Assisted Acceptance and Commitment Therapy-Based Intervention. JMIR Aging 2024; 7:e47943. [PMID: 38647321 PMCID: PMC11058557 DOI: 10.2196/47943] [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: 04/06/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 04/25/2024] Open
Abstract
In this article, we will provide a rationale for a web-assisted acceptance and commitment therapy (ACT) approach to loneliness among older adults, drawing upon theories from the literature on adult development and aging, emotion regulation, and loneliness. The intervention program was developed using the principles of ACT, which is a cognitive behavioral approach and unified model of human behavior change and psychological growth. The ACT intervention focuses on developing nonjudgmental present-focused awareness of internal experiences (thoughts, emotions, and memories) through strategies such as acceptance and mindfulness rather than directly modifying or removing them per se. The ACT intervention appears well-suited to assist older adults in coping with the challenges of aging, as the focus is on an individual’s willingness to sit with internal experiences out of one’s control (ie, acceptance), stepping back from negative or critical thoughts and developing greater kindness toward oneself (ie, defusion), discerning what is most important to one’s true self (ie, values), and building larger patterns of effective action based on such values (ie, committed action). The ACT intervention was developed as a resource for older adults who are socially isolated or having difficulty with social connectedness. Eight modules comprise the web-assisted ACT intervention program, which includes reading materials, video clips, and activities. Each module is followed by a summary, a homework assignment, a short quiz to assess learning, and a moderated discussion with a coach. The intervention program begins with reconnecting participants with their values. The goal of the ACT intervention program is to foster flexibility in a participant’s behavior so they can behave consistently with their chosen values, rather than becoming locked into a pattern of behavior that is driven by avoiding distress or discomfort. The ACT intervention approach is both novel and innovative, as it is based on ACT and leverages a behavioral health web platform that is flexible and inclusive in its design. The ACT intervention aims to help older adults become more socially connected, less lonely, and more satisfied with their relationships with other people. The emphasis that ACT places on values and living life in accordance with one’s values renders it an approach ideally suited to older adults. Finally, recommendations for future research regarding this approach to addressing loneliness among older adults is addressed.
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Affiliation(s)
- Amie Zarling
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, United States
| | - Joseph Kim
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, United States
| | - Daniel Russell
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, United States
| | - Carolyn Cutrona
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, United States
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Pelucio L, Dourado MCN, Quagliato LA, Nardi AE. Home care for the elderly with dementia: a systematic review. Dement Neuropsychol 2023; 17:e20220052. [PMID: 37965481 PMCID: PMC10642071 DOI: 10.1590/1980-5764-dn-2022-0052] [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: 10/29/2022] [Accepted: 01/20/2023] [Indexed: 11/16/2023] Open
Abstract
Objetive With the global population aging, there is a growing need for home-based care to meet the health needs of the elderly. However, the quality of care provided to the aged population is now arguably a significant challenge for most healthcare systems worldwide. Methods The present review included 13 original studies on home care and its effects on dementia patients, describing how patient care and adequate treatment can be collaborative for their improvement, for case management, and optimizing pain control and specificities. Results Among the findings, it was evidenced that the environment impacts the form of care, once being at home can improve communication and global monitoring of dementia patients. Conclusion In addition to the results analyzed in this review, there is a need for future, well-designed studies on the different aspects of home care, highlighting the importance of evaluating the type of care for each patient in the quest to optimize the care.
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Affiliation(s)
- Luísa Pelucio
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Depression Resistant Ambulatory, Rio de Janeiro RJ, Brazil
| | | | | | - Antonio Egidio Nardi
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Depression Resistant Ambulatory, Rio de Janeiro RJ, Brazil
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Bölenius K, Lämås K, Sandman PO, Lindkvist M, Edvardsson D. Perceptions of self-determination and quality of life among Swedish home care recipients - a cross-sectional study. BMC Geriatr 2019; 19:142. [PMID: 31126243 PMCID: PMC6534922 DOI: 10.1186/s12877-019-1145-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/24/2019] [Indexed: 11/24/2022] Open
Abstract
Background It is acknowledged that preservation of self-determination is very important in order for older adults to experience good quality of life, but to what degree and in what areas people receiving help from home care service experience self-determination is unknown. Few studies have examined the perception of self-determination in relation to quality of life among older adults living at home with help from home care services. Thus, the aim of this study was to explore perceptions of self-determination among older adults living at home with the support of home care services, and to test whether older adults who perceive a higher degree of self-determination also feel they have a better quality of life. Methods This cross-sectional study was conducted in one municipality in northern Sweden. A total of 134 older adults (≥ 65 years) were included. Data were collected by means of a survey including questionnaires about background characteristics, self-determination, and health-related quality of life. Descriptive statistics regarding background characteristics for groups with high and low self-determination respectively were presented and the differences between the groups were analyzed using the Chi-square test and the Mann-Whitney U test. Results Our main finding shows that the majority of older adults with support from home care services experience self-determination in the dimensions use of time, and self-care. However, a wide variation was found in self-reported self-determination in all dimensions. Results also show that the group with higher self-reported self-determination also reported a greater degree of experienced quality of life in comparison with the group with lower self-reported self-determination. Conclusions In line with earlier research, our results found a positive relation between self-determination and quality of life. The results are relevant for the care of older adults and indicate a need of further research. The results presented in this paper could serve as a guide when planning for improved self-determination among older adults in home care service. Trial registration NCT02846246.
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Affiliation(s)
- Karin Bölenius
- Department of Nursing, Umeå University, 90187, Umeå, Sweden.
| | - Kristina Lämås
- Department of Nursing, Umeå University, 90187, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, 90187, Umeå, Sweden.,Division of Caring Sciences, Depart Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, 90187, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Abstract
UNLABELLED ABSTRACTObjective:With the aging of the population, the demand for long-term services is increasing accordingly and the recruitment of paid caregivers to older adults has become a critical issue. Hence, there is a great need to train people in the care of older adults. This study examined motivations to participate in a new program, which aims to train young people (ages 19-25) to become paid caregivers for older adults. METHODS The study is based on focus groups with program participants (N = 33) and on phone interviews with former participants (N = 8) and face-to-face interviews with staff members (N = 14). Transcripts were analyzed using qualitative content analysis. RESULTS Three major themes emerged: (1) "Motivations to participate in the program," referred to participants' motivations to work with older adults. (2) "Reduced motivations due to ambiguity of roles," referred to the unclear definition of the care worker's role, which created a decrease in participants' motivations to provide care. (3) "Inadequate financial compensation," concerned participants' reduced motivation to participate in the program as a result of financial promises that were not realized. CONCLUSIONS Findings suggest that it is important to be cautious about the motivations for participation in the program because by emphasizing the difficult situation of older adults, one stresses the low status assigned to older adults, rather than positive attributes. It is also suggested that care workers should be financially rewarded, so that despite the difficulties that may arise during work, they will feel valued and will want to remain in the profession.
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Wang J, Simmons SF, Maxwell CA, Schlundt DG, Mion LC. Home Health Nurses' Perspectives and Care Processes Related to Older Persons with Frailty and Depression: A Mixed Method Pilot Study. J Community Health Nurs 2018; 35:118-136. [PMID: 30024285 DOI: 10.1080/07370016.2018.1475799] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objectives of this study were (1) to describe home health care (HHC) nurses' perception of and care processes related to geriatric depression and frailty, and (2) to identify barriers to care delivery for older persons with these two conditions. Ten semi-structured interviews were conducted with HHC nurses, and 16 HHC nursing visits to 16 older patients (≥65 years) were observed. Mixed method analysis showed that HHC nurses did not routinely assess for frailty and depression. Major barriers to care delivery included insufficient training, documentation burden, limited reimbursement, and high caseload. Addressing these barriers would facilitate HHC nursing care for frail, depressed elders.
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Affiliation(s)
- Jinjiao Wang
- a School of Nursing , University of Rochester Medical Center , Rochester , New York
| | - Sandra F Simmons
- b Center for Quality Aging, Division of Geriatrics, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee.,c Geriatric Research, Education and Clinical Center (GRECC) , VA Tennessee Valley Healthcare System , Nashville , Tennessee
| | - Cathy A Maxwell
- d School of Nursing , Vanderbilt University , Nashville , Tennessee
| | - David G Schlundt
- e Department of Psychology , Vanderbilt University , Nashville , Tennessee
| | - Lorraine C Mion
- f College of Nursing , The Ohio State University , Columbus , Ohio
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Abstract
RÉSUMÉLes prévisions liées au vieillissement de la population canadienne impliquent que la demande en soins à domicile augmentera significativement. À ce jour, peu d’études ont été menées au Canada sur les soins à domicile pour les personnes âgées, notamment sur les caractéristiques des bénéficiaires de soins à domicile, les lacunes dans les services, ou les interventions permettant de répondre aux besoins des clients en matière de soins à domicile. Une revue systématique de sept bases de données électroniques a été réalisée pour les années 2000-2016 afin d’examiner les connaissances actuelles dans le domaine des soins à domicile pour les personnes âgées au Canada. Cette synthèse était centrée sur quatre principaux thèmes retrouvés dans la littérature : les prédicteurs au niveau de la personne âgée, les besoins de soins non comblés, les interventions, les enjeux et les défis dans les soins à domicile. Cette revue a mis en évidence plusieurs lacunes dans les connaissances liées aux soins à domicile pour les personnes âgées au Canada, considérant que plus de la moitié des études étaient centrées sur le contexte ontarien. Bien que des stratégies prometteuses aient été mises en évidence, davantage de recherche et d’évaluation des interventions et des résultats sont requises pour appuyer efficacement le système de soins à domicile au Canada, à court et à long terme.
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Johnson S, Bacsu J. Understanding complex care for older adults within Canadian home care: a systematic literature review. Home Health Care Serv Q 2018; 37:232-246. [PMID: 29578846 DOI: 10.1080/01621424.2018.1456996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In the context of an aging population, both the need for home care services and its complexity of care have increased in many high-income countries. Yet, the definition of what constitutes complex care is largely elusive. This systematic review examined the conceptual definition of complex care within the home care environment using several social and health science databases for research published from 2000 to 2017. Of the 25 articles and reports identified, only 16 addressed complex care specifically and included older adults, aging, and/or home care. The results showed that complex care for older adults is primarily defined from a biomedical approach focusing on chronic disease and management and less commonly from the perspective of the social determinants of health. Future studies should consider the importance of the continuum of care needs from both the biomedical and the social determinants to adequately plan and provide care for older adults.
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Affiliation(s)
- Shanthi Johnson
- a Faculty of Kinesiology and Health Studies and Saskatchewan Population Health and Evaluation Research Unit , University of Regina , Regina , Canada
| | - Juanita Bacsu
- a Faculty of Kinesiology and Health Studies and Saskatchewan Population Health and Evaluation Research Unit , University of Regina , Regina , Canada
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Markle-Reid M, McAiney C, Forbes D, Thabane L, Gibson M, Browne G, Hoch JS, Peirce T, Busing B. An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms. BMC Geriatr 2014; 14:62. [PMID: 24886344 PMCID: PMC4019952 DOI: 10.1186/1471-2318-14-62] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services. Methods A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation. Results Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. Conclusions Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms. Trial registration Clinicaltrials.gov identifier: NCT01407926.
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Functional decline and mortality in long-term care settings: Static and dynamic approach. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jcgg.2013.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Acceptance and Commitment Therapy with Older Adults: Rationale and Considerations. COGNITIVE AND BEHAVIORAL PRACTICE 2013; 20:47-56. [PMID: 26997859 DOI: 10.1016/j.cbpra.2011.07.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Older adults are the fastest growing segment of the population. With these changing demographics, mental health professionals will be seeing more older clients. Additionally, older adults are an underserved population in that most older adults in need of mental health services do not receive treatment. Thus, it is essential that treatments for mental and behavioral health problems are empirically supported with older adults and that mental health professionals are aware of the special needs of older adult populations. Acceptance and Commitment Therapy (ACT) is an emerging approach to the treatment of distress. The purpose of this article is to provide a rationale for using ACT with older adults based on gerontological theory and research. We also review research on ACT-related processes in later life. We present a case example of an older man with depression and anxiety whom we treated with ACT. Finally, we describe treatment recommendations and important adaptations that need to be considered when using ACT with older adults and discuss important areas for future research.
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Choi NG, Hegel MT, Marinucci ML, Sirrianni L, Bruce ML. Association between participant-identified problems and depression severity in problem-solving therapy for low-income homebound older adults. Int J Geriatr Psychiatry 2012; 27:491-9. [PMID: 21638330 PMCID: PMC3196815 DOI: 10.1002/gps.2741] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 04/04/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the relationship between the severity of baseline depressive symptoms and the problems that low-income homebound older adults (n = 66) identified in their problem-solving therapy (PST) sessions. METHODS Depressive symptoms were measured with the 24-item Hamilton Rating Scale for Depression (HAMD). Participant-identified problems recorded in the therapists' worksheets were coded into seven categories: living arrangement/housing issues, financial/health care expense issues, family or other relationship issues, hygiene/task issues, social isolation issues, physical/functional health issues, and mental/emotional health issues. T-tests and ordinary least squares regression analyses were used to examine differences in HAMD scores between those who identified any problem in each category and those who did not. RESULTS Participants who had living arrangement/housing and family or other relationship issues had higher baseline HAMD scores than the rest of the participants. At 2-week posttest, those with living arrangement/housing issues continued to have higher HAMD scores than the others, whereas those with family or other relationship issues did not. CONCLUSION The study findings provide insights into the problems that low-income, depressed homebound individuals bring to their PST sessions. It was not clear if family conflict or other relationship issues contributed to their depression or vice versa, but it appears that PST may have contributed to alleviating depressive symptoms associated with these issues. Precarious living/housing situations appeared to have had a serious depressogenic effect and could not be easily resolved within a short time frame of the PST process, as these issues required formal support.
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Choi NG, Bruce ML, Sirrianni L, Marinucci ML, Kunik ME. Self-reported antidepressant use among depressed, low-income homebound older adults: class, type, correlates, and perceived effectiveness. Brain Behav 2012; 2:178-86. [PMID: 22574284 PMCID: PMC3345360 DOI: 10.1002/brb3.48] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 01/20/2012] [Accepted: 02/09/2012] [Indexed: 01/07/2023] Open
Abstract
Little research has been done on the use of antidepressants among homebound older adults, especially low-income homebound older adults, and their perceptions of the effectiveness of their medication. The purposes of this study were to examine self-reported use of antidepressants among depressed homebound older adults, class and type of antidepressants used, individual-level correlates of antidepressant use, and users' perceptions of the effectiveness of antidepressants. Data on self-reported use of antidepressants were obtained as part of a feasibility study of short-term telehealth problem-solving therapy for depressed low-income homebound adults (n = 162) aged 50 or older. The 24-item Hamilton Rating Scale for Depression (HAMD) was used to assess depression severity. The findings show that about half of the study participants were taking antidepressants, with 26.6% of those on antidepressants rating their medications very effective and 21.5% rating them effective. Female gender was positively, but older age and being Black/African American were negatively associated with the likelihood of antidepressant use. Perceived effectiveness of antidepressants was negatively associated with older age and the HAMD score. The findings suggest that personalized approaches to depression management may be needed in subgroups of depressed older adults, including culturally tailored medication counseling in Black/African-American older adults.
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