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Holmes SD, Scherr S, O'Brien E, Levy S, Gurlu M, Zhu S, Galik E, Resnick B. Testing the feasibility and preliminary efficacy of Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD) intervention for residents with dementia in assisted living: Protocol description. Res Nurs Health 2024. [PMID: 38994689 DOI: 10.1002/nur.22415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 06/14/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
The purpose of this manuscript is to describe the protocol for an Alzheimer's Association-funded cluster randomized trial that focuses on engaging assisted living residents with dementia in meaningful activity to help address their behavioral symptoms of distress using a theoretically based approach, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). The development of MAC-4-BSD was based on the Social Ecological Model and Social Cognitive Theory. The MAC-4-BSD intervention includes the following four steps: (1) Assessment of the assisted living physical environment and policies to facilitate meaningful activity; (2) Education of staff about implementation of meaningful activity; (3) Assessment of resident preferences and goals for meaningful activity; (4) Mentoring and motivating staff and residents to facilitate engagement in meaningful activity. The overall aim of this study will be to determine the feasibility and preliminary efficacy of implementing the MAC-4-BSD intervention and test whether it will improve residents' engagement in meaningful activity, behavioral symptoms of distress, and quality of life as well as the environment and policies to promote meaningful activity in assisted living.
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Affiliation(s)
- Sarah D Holmes
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Susan Scherr
- Berman School of Nursing and Health Professions, Stevenson University, Owings Mills, Maryland, USA
| | - Erin O'Brien
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Sorah Levy
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Merve Gurlu
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Shijun Zhu
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Elizabeth Galik
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Barbara Resnick
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
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Hoben M, Li W, Dampf H, Hogan DB, Corbett K, Chamberlain SA, McGrail K, Griffith LE, Gruneir A, Lane NE, Baumbusch J, Maxwell C. Caregiver Involvement and Concerns with Care of Residents of Assisted Living before and during the COVID-19 Pandemic. Gerontology 2023; 69:839-851. [PMID: 37068467 DOI: 10.1159/000530622] [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: 11/15/2022] [Accepted: 04/03/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Family/friend caregivers play an essential role in promoting the physical and mental health of older adults in need of care - especially during the COVID-19 pandemic and especially in assisted living (AL) homes, where resident care needs are similarly complex as in long-term care homes but fewer staffing resources and services are available. However, little research is available on caregiver involvement and concerns with care of AL residents prior to and during waves 1 and 2 of the COVID-19 pandemic. This study addressed this important knowledge gap. METHODS This prospective cohort study used baseline and follow-up online surveys with primary caregivers to AL residents in Western Canada who were 65 years or older and had lived in the AL home for at least 3 months before Mar 1, 2020. Surveys assessed the following outcomes in the 3 months prior to and during waves 1 and 2 of the pandemic: sociodemographics, 5 ways of visiting or communicating with residents, involvement in 16 care tasks, concerns with 9 resident physical/mental health conditions, perceived lack of resident access to 7 care services, and whether caregivers felt well informed and involved with resident care. RESULTS Based on 386 caregiver responses, in-person visits dropped significantly in wave 1 of the pandemic and so did caregiver involvement in nearly all care tasks. While these rates increased in wave 2, most did not return to pre-pandemic levels. Correspondingly, caregiver concerns (already high before the pandemic) substantially increased in wave 1 and stayed high in wave 2. These were particularly elevated among caregivers who did not feel well informed/involved with resident care. CONCLUSIONS Restricted in-person visiting disrupted resident care and was associated with worse perceptions of resident health and well-being. Continued caregiver involvement in resident care and communication with caregivers even during lockdowns is key to mitigating these issues.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Wenshan Li
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Hana Dampf
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kim McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- ICES, Toronto, Ontario, Canada
| | - Natasha E Lane
- ICES, Toronto, Ontario, Canada
- Department of Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Maxwell
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Schwartz LB, Lieblich C, Laxton CE, Kaes L, Barnett DP, Port C, Pace DD. COVID-19 in Assisted Living: Protecting a Critical Long-Term Care Resource. J Am Med Dir Assoc 2023; 24:134-139. [PMID: 36592942 PMCID: PMC9801232 DOI: 10.1016/j.jamda.2022.12.012] [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: 08/08/2022] [Revised: 11/17/2022] [Accepted: 12/10/2022] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic had a big impact on assisted living (AL), a vital setting in long-term care (LTC). Understanding the strengths and opportunities for improvement through practice, policy, and research are essential for AL to be prepared for the next pandemic and other challenges. AL communities experienced the pandemic in unique ways, because of varying regulatory environments, differences in familiarity with using and procuring personal protective equipment not typically used in AL (such as N95 masks), loss of family involvement, the homelike environment, and lower levels of licensed clinical staff. Being state rather than federally regulated, much less national data are available about the COVID-19 experience in AL. This article reviews what is known about cases and deaths, infection control, and the impact on residents and staff. For each, we suggest actions that could be taken and link them to the Assisted Living Workgroup Report (ALW) recommendations. Using the Center for Excellence in Assisted Living (CEAL) 15-year ALW report, we also review which of these recommendations have and have not been implemented by states in the preceding decade and half, and how their presence or absence may have affected AL pandemic preparedness. Finally, we provide suggestions for policy, practice, and research moving forward, including improving state-level reporting, staff vaccine requirements, staff training and work-life, levels of research-provider partnerships, dissemination of research, and uptake of a holistic model of care for AL.
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Affiliation(s)
- Lindsay B Schwartz
- Center for Excellence in Assisted Living (CEAL), Workforce & Quality Innovations, LLC, Bear Creek, NC, USA.
| | - Cathy Lieblich
- Center for Excellence in Assisted Living (CEAL), Pioneer Network, Orlando, FL, USA
| | - Christopher E Laxton
- Center for Excellence in Assisted Living (CEAL), AMDA, The Society for Post-Acute and Long-Term Care Medicine, Columbia, MD, USA
| | - Loretta Kaes
- Center for Excellence in Assisted Living (CEAL), American Assisted Living Nurses Association (AALNA), NAPA, CA, USA
| | - D Pearl Barnett
- Center for Excellence in Assisted Living (CEAL), ADvancing States, Arlington, VA, USA
| | | | - Douglas D Pace
- Center for Excellence in Assisted Living (CEAL), Alzheimer's Association, Washington, DC, USA
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Araujo O, Sequeira C, Ferré-Grau C, Sousa L. [Nursing homes in Portugal during the COVID-19 outbreak: Challenges for the future]. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32:83-91. [PMID: 35577413 PMCID: PMC9099353 DOI: 10.1016/j.enfcle.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/18/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study sought to explore the perceptions of experts about the performance of nursing homes during the COVID-19 outbreak. METHOD A qualitative study was developed in two stages: (1) a focus group, conducted in May 2020, with 5 experts; (2) a modified e-Delphi, implemented in September 2020 with 22 experts, both in the area of assistance in nursing homes from Northern and Center of Portugal. RESULTS The results allowed identifying three main areas that influenced the performance of nursing homes during the COVID-19 outbreak: organization models and resources; physical and mental health of residents and; family as a support. CONCLUSIONS Older adults residing in nursing homes are particularly vulnerable to severe disease or death from COVID-19. It is emergent that nursing homes prevent physical and mental frailty in older residents and the loneliness aggravated by the pandemic circumstances. Decision-makers need to recognize that older people living in nursing homes have several health needs, which should determine the implementation of new strategies namely the increase in the number of professionals with appropriate skills.
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Affiliation(s)
- Odete Araujo
- School of Nursing, University of Minho, Portugal; Health Sciences Research Unit, Nursing (UICISA E: UMinho), Portugal; CINTESIS-Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal.
| | - Carlos Sequeira
- CINTESIS-Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal; Nursing School of Porto, Porto, Portugal
| | - Carme Ferré-Grau
- Department of Nursing, University Rovira i Virgili, Tarragona, España
| | - Lia Sousa
- Escola Superior de Saúde do Vale do Ave, CESPU, Vila Nova de Famalicão, Portugal
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5
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Araujo O, Sequeira C, Ferré-Grau C, Sousa L. [Nursing homes in Portugal during the COVID-19 outbreak: Challenges for the future]. ENFERMERIA CLINICA 2022; 32:83-91. [PMID: 34690492 PMCID: PMC8526444 DOI: 10.1016/j.enfcli.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
Objective This study sought to explore the perceptions of experts about the performance of nursing homes during the COVID-19 outbreak. Method A qualitative study was developed in two stages: (1) a focus group, conducted in May 2020, with 5 experts; (2) a modified e-Delphi, implemented in September 2020 with 22 experts, both in the area of assistance in nursing homes from Northern and Center of Portugal. Results The results allowed identifying three main areas that influenced the performance of nursing homes during the COVID-19 outbreak: organization models and resources; physical and mental health of residents and; family as a support. Conclusions Older adults residing in nursing homes are particularly vulnerable to severe disease or death from COVID-19. It is emergent that nursing homes prevent physical and mental frailty in older residents and the loneliness aggravated by the pandemic circumstances. Decision-makers need to recognize that older people living in nursing homes have several health needs, which should determine the implementation of new strategies namely the increase in the number of professionals with appropriate skills.
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Affiliation(s)
- Odete Araujo
- School of Nursing, University of Minho, Portugal
- Health Sciences Research Unit, Nursing (UICISA E: UMinho), Portugal
- CINTESIS-Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal
| | - Carlos Sequeira
- CINTESIS-Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal
- Nursing School of Porto, Porto, Portugal
| | - Carme Ferré-Grau
- Department of Nursing, University Rovira i Virgili, Tarragona, España
| | - Lia Sousa
- Escola Superior de Saúde do Vale do Ave, CESPU, Vila Nova de Famalicão, Portugal
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Ciofi JM, Kemp CL, Bender AA. Assisted Living Residents with Dementia: Being Out in the World and Negotiating Connections. THE GERONTOLOGIST 2021; 62:200-211. [PMID: 34370003 DOI: 10.1093/geront/gnab113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons living with dementia, including long-term care residents, and their care partners emphasize the importance of meaningful engagement and stress the need for activity and opportunities to go outdoors or offsite. Yet, little is known about getting out in this population. Here, our objectives are to: 1) identify residents' opportunities for, and experiences with, getting out; 2) understand the significance of getting out; and 3) explain influential factors. RESEARCH DESIGN AND METHODS Guided by grounded theory methods, we analyzed qualitative data collected over a one-year period in four diverse assisted living communities. We followed 33 residents with dementia and their care partners. Data include detailed fieldnotes capturing 1,560 observation hours, 114 interviews with residents (where possible), assisted living staff, family members, and other visitors, and record review. RESULTS We identified the centrality of "being out in the world and negotiating connections," which characterizes residents' experiences with the outside world as a process of 'working out' engagement with nature, others, and the community. Being out in the world was consequential to well-being and quality of life. Most residents got out at least occasionally; some lacked opportunities. Among residents who got out, most benefitted from ensuing connections. Yet, not all experiences were positive. Being out in the world varied over time and by individual-, convoy-, AL community-, and neighborhood-level factors. DISCUSSION AND IMPLICATIONS We discuss the implications of our findings for research and practice surrounding meaningful engagement among persons with dementia, including during crises such as the pandemic.
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Affiliation(s)
- Joy M Ciofi
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
| | - Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA.,Department of Sociology, Georgia State University, Atlanta, Georgia, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Emory School of Medicine, Atlanta, Georgia, USA
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Thodberg K, Videbech PB, Hansen TGB, Pedersen AB, Christensen JW. Dog visits in nursing homes - increase complexity or keep it simple? A randomised controlled study. PLoS One 2021; 16:e0251571. [PMID: 34038451 PMCID: PMC8153477 DOI: 10.1371/journal.pone.0251571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the immediate response of nursing home residents to dog visits with or without an activity, and the impact of cognitive ability. Methods In a randomly controlled trial, 174 nursing home residents were allocated to 12 bi-weekly 10-minute visits: either ordinary dog visits (D, n = 57, 49 analysed), dog visits with an activity (DA, n = 56, 48 analysed), or visits with activity but no dog (A, n = 61, 54 analysed). We recorded frequency and duration of residents’ verbal and physical interactions with the dog and persons. Data were analysed in three periods of four visits (period 1–3) as binomial variables (generalised linear models) or durations (non-parametric statistics). Results Both visit type and impairment level affected the likelihood of interacting with the dog (D and DA). In some periods increased cognitive impairment lowered odds of touching the dog in DA visits (period 1: F1,85 = 5.17, P < 0.05) and talking to it directly (period 1: F1,90 = 4.60, P < 0.05; period 3: F1,87 = 5.34, P < 0.05). Throughout, residents talked less to persons during DA visits compared to D and A (P = 0.01–0.05), and level of cognitive impairment correlated negatively with talk duration (P < 0.001). Generally, high cognitive impairment level lowered odds of interacting with (period 1: F1,89 = 7.89, P < 0.01; period 2: F1,97 = 6.76, P = 0.01; period 3: F1,92 = 13.57, P < 0.001) and talking about the activities (period 1: F1,89 = 13.78, P <0.001; period 2: F1,88 = 3.27, P = 0.07; period 3: F1,86 = 3.88, P = 0.05). Conclusion Visits without specific activities stimulated residents to interact with the dog, whereas increasing the complexity of dog visits by adding activities resulted in less interaction with the dog for severely impaired residents. The optimal dog visit for the less cognitively impaired residents could include activities and thereby a possibility to interact with the dog in different ways, whereas for severely impaired residents, just being with the dog seems more appropriate.
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Affiliation(s)
- Karen Thodberg
- Department of Animal Science, Aarhus University, Aarhus, Denmark
- * E-mail:
| | | | - Tia G. B. Hansen
- Center for Developmental and Applied Psychological Science, Aalborg University, Aalborg, Denmark
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Kemp CL. #MoreThanAVisitor: Families as "Essential" Care Partners During COVID-19. THE GERONTOLOGIST 2021; 61:145-151. [PMID: 33295960 PMCID: PMC7799094 DOI: 10.1093/geront/gnaa161] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 11/30/2022] Open
Abstract
The public health response to the current Coronavirus pandemic in long-term care communities, including assisted living, encompasses prohibiting visitors. This ban, which includes family members, has been criticized for being unfair, unhealthy, and unsafe. Against this backdrop, I examine the roles family play in residents' daily lives and care routines. I argue that classifying family as "visitors" rather than essential care partners overlooks their critical contributions and stems from taken-for-granted assumption about gender, families, and care work, and I demonstrate why families are more than visitors. Policies that ban family visits also reflect a narrow understanding of health that focuses on mitigating infection risk, but neglects overall health and well-being. This policy further stems from a limited comprehension of care relations. Research shows that banning family visits has negative consequences for residents, but also families themselves, and direct care workers. I argue that identifying ways to better understand and support family involvement is essential and demonstrate the utility of the Convoys of Care model for guiding the reconceptualization of family in long-term care research, policy, and practice during and beyond the pandemic.
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Affiliation(s)
- Candace L Kemp
- The Gerontology Institute and Department of Sociology, Georgia State University, Atlanta, USA
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