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Astell A, Dosanjh S, D'Elia T, Kokorelias KM, Stewart S, Grigorovich A, McMurray J, Iaboni A. Personalized Tablets for Residents in Long-Term Care to Support Recreation and Mitigate Isolation. J Am Med Dir Assoc 2024; 25:105022. [PMID: 38763162 DOI: 10.1016/j.jamda.2024.105022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES There is a digital divide in long-term care homes (LTCHs), with few residents having regular access to internet-connected devices. In this study, we provided long-term care residents with personalized and adapted tablets. We aimed to understand what factors influenced tablet use and the impact of tablet access on opportunities for social connection and recreation. DESIGN A pragmatic, mixed-methods multicenter, open-label, uncontrolled interventional study with assessment of outcomes at baseline and 3 months. SETTING AND PARTICIPANTS A total of 58 resident-care partner dyads were recruited across 7 LTCHs in Ontario, Canada. The main inclusion criterion was having a care partner willing to participate, and we excluded residents who already had an internet-connected device. METHODS Resident demographics, functional status assessments, and recreational engagement were captured using items from the Resident Assessment Instrument/Minimum Data Set. Care partners completed a questionnaire about relational closeness and site leads assessed resident quality of life before and approximately 3 months after tablet distribution. Interviews with 23 care partners and 7 residents post-implementation were completed and analyzed. RESULTS The median tablet use by participants was 7 minutes (interquartile range 27) per day on average over the study period. Predictors of higher tablet use were younger age, higher cognitive functioning, absence of hearing impairment, and having a care partner who lives farther away. There was no improvement on quantitative measures of quality of life, recreation, or relational closeness. In interviews, participants identified many different opportunities afforded by access to personalized tablets. CONCLUSIONS AND IMPLICATIONS Some LTCH residents without current access to the internet benefit from being provided a personal tablet and use it in a variety of ways to enrich their lives. There is a critical need to bridge the digital divide for this population.
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Affiliation(s)
- Arlene Astell
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada; Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Serena Dosanjh
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Teresa D'Elia
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Kristina M Kokorelias
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada; Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Section of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Toronto, Ontario, Canada; National Institute on Ageing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Steven Stewart
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Alisa Grigorovich
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada; Recreation and Leisure Studies, Brock University, St. Catharines, Ontario, Canada
| | - Josephine McMurray
- Lazaridis School of Business & Economics/Community Health, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Chu C, Donato-Woodger S, Khan SS, Shi T, Leslie K, Abbasgholizadeh-Rahimi S, Nyrup R, Grenier A. Strategies to Mitigate Age-Related Bias in Machine Learning: Scoping Review. JMIR Aging 2024; 7:e53564. [PMID: 38517459 PMCID: PMC10998175 DOI: 10.2196/53564] [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: 10/11/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Research suggests that digital ageism, that is, age-related bias, is present in the development and deployment of machine learning (ML) models. Despite the recognition of the importance of this problem, there is a lack of research that specifically examines the strategies used to mitigate age-related bias in ML models and the effectiveness of these strategies. OBJECTIVE To address this gap, we conducted a scoping review of mitigation strategies to reduce age-related bias in ML. METHODS We followed a scoping review methodology framework developed by Arksey and O'Malley. The search was developed in conjunction with an information specialist and conducted in 6 electronic databases (IEEE Xplore, Scopus, Web of Science, CINAHL, EMBASE, and the ACM digital library), as well as 2 additional gray literature databases (OpenGrey and Grey Literature Report). RESULTS We identified 8 publications that attempted to mitigate age-related bias in ML approaches. Age-related bias was introduced primarily due to a lack of representation of older adults in the data. Efforts to mitigate bias were categorized into one of three approaches: (1) creating a more balanced data set, (2) augmenting and supplementing their data, and (3) modifying the algorithm directly to achieve a more balanced result. CONCLUSIONS Identifying and mitigating related biases in ML models is critical to fostering fairness, equity, inclusion, and social benefits. Our analysis underscores the ongoing need for rigorous research and the development of effective mitigation approaches to address digital ageism, ensuring that ML systems are used in a way that upholds the interests of all individuals. TRIAL REGISTRATION Open Science Framework AMG5P; https://osf.io/amg5p.
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Affiliation(s)
- Charlene Chu
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Knowledge, Innovation, Talent, Everywhere (KITE), Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute for Life Course and Aging, Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Simon Donato-Woodger
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Shehroz S Khan
- Knowledge, Innovation, Talent, Everywhere (KITE), Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Tianyu Shi
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Department of Civil Engineering, University of Toronto, Toronto, ON, Canada
| | - Kathleen Leslie
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
| | | | - Rune Nyrup
- Centre for Science Studies, Department of Mathematics, Aarhus University, Aarhus, Denmark
| | - Amanda Grenier
- Factor-Inwentash Faculty of Social Work, University of Toronto and Baycrest Hospital, Toronto, ON, Canada
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Garnett A, Pollock H, Prentice K, Floriancic N, Donelle L, Hand C, Oudshoorn A, Babenko-Mould Y, Forchuk C. Health Provider Experiences in Supporting Social Connectedness Between Families and Older Adults Living in Long-Term Care Homes. SAGE Open Nurs 2024; 10:23779608241239314. [PMID: 38515527 PMCID: PMC10956142 DOI: 10.1177/23779608241239314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 02/15/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Many people, often older adults, living in long-term care homes (OA-LTCH) became socially isolated during the COVID-19 pandemic due to variable restrictions on in-person visits and challenges associated with using technology for social connectivity. Health providers were key to supporting these OA by providing additional care and facilitating their connections with family using technology such as smartphones and iPads. It is important to learn from these experiences to move forwards from the COVID-19 pandemic with evidence-informed strategies that will better position health providers to foster social engagement for OA-LTCH across a range of contextual situations. Objective This exploratory qualitative description study sought to explore health provider experiences in supporting social connectedness between family members and OA-LTCH within the COVID-19 context. Methods Qualitative, in-depth semistructured interviews were conducted with 11 health providers. Results Using inductive qualitative content analysis study findings were represented by the following themes: (a) changes in provider roles and responsibilities while challenging for health providers did not impact their commitment to supporting OA-LTCH social and emotional health, (b) a predominant focus on OA-LTCH physical well-being with resultant neglect for emotional well-being resulted in collective trauma, and (c) health providers faced multiple challenges in using technology to support social connectivity. Conclusion Study findings suggest the need for increased funding for LTC to support activities and initiatives that promote the well-being of health providers and OA living in LTC, the need to prioritize social well-being during outbreak contexts, and more formalized approaches to guide the appropriate use of technology within LTC.
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Affiliation(s)
| | | | | | | | | | - Carri Hand
- Western University, London, Ontario, Canada
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Cruise D, Sinden D, Jaana M. Older Adults' Quality of Life in Long-Term Care: A Cross-Sectional Comparison Before and During the COVID-19 Pandemic. Can J Aging 2023; 42:744-753. [PMID: 37424446 DOI: 10.1017/s0714980823000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
This study aims to assess changes in long-term care (LTC) residents' quality of life (QoL) before and during the COVID-19 pandemic. A pre-test post-test study of 49 QoL measures, across four dimensions from the interRAI self-reported QoL survey, was conducted. Secondary data from 2019 (n = 116) and 2020 (n = 128) were analysed to assess the change in QoL. A significant decline in 12 measures was observed, indicating a change in QoL of LTC residents during the pandemic. Social life was the dimension mostly affected with residents reporting less opportunities to spend time with like-minded residents, explore new skills and interests, participate in meaningful religious activities, and have enjoyable things to do in the evenings. Several measures of personal control, staff responsiveness and care, and safety also demonstrated a significant change. The results can inform future strategies for pandemic and outbreak preparedness. Balancing the safety of residents with attention to their QoL should be a priority moving forward.
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Affiliation(s)
- Danielle Cruise
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Danielle Sinden
- Centre of Excellence in Frailty-Informed CareTM, Perley Health, Ottawa, ON, Canada
| | - Mirou Jaana
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
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DesChâtelets JR, Khowaja AR, Mechelse K, Koning H, Ventresca D. Exploring the Access and Use of Social Technologies by Older Adults in Support of Their Mental Health During the COVID-19 Pandemic: A Rapid Review. Can J Aging 2023; 42:728-743. [PMID: 37727886 DOI: 10.1017/s0714980823000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Coronavirus disease (COVID-19) lockdowns disproportionately affect older people where most suffer from social isolation and loneliness, which translate into higher rates of depression and anxiety. This study aimed to explore the accessibility, outcomes, and challenges of social technology use among community-dwelling older adults, older adults in long-term care, older adults with neurocognitive disorder, and older adults with pre-frailty and frailty, to help guide future research in this area. A rapid review was conducted, and articles were retrieved from four online databases, including Medline, AgeLine, EconLit and CINAHL, and grey literature from Google Scholar. Of the 131 articles retrieved, 24 were included in this review. The positive outcomes of social technology use include improved mental and physical health, reduced health disparities, and increased autonomy. Adverse outcomes include furthering the digital divide. More research surrounding the economic impacts of social technologies is warranted.
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de Lacerda TTB, Assis MG, de Carvalho PF, Pereira LSM. Did managers of long-term care facilities neglect the functionality of older adults? A survey during the COVID-19 pandemic. Am J Infect Control 2023; 51:1350-1355. [PMID: 37149265 PMCID: PMC10158166 DOI: 10.1016/j.ajic.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
Physical distancing impaired the health of older adults living in long-term care facilities (LTCF). This study aimed to assess the perception of managers of Brazilian LTCF about the loss of functionality of residents and strategies to prevent it. In this cross-sectional study, 276 managers of LTCF from all Brazilian regions responded to an online survey, following the Checklist for Reporting Results of Internet E-Surveys. The managers reported a loss of cognitive (60.2%) and physical (48.2%) functionality and more depressive symptoms (77.9%) and falls (16.3%) in residents. In addition, 73.2% of LTCFs reduced in-person activities, and 55.8% did not perform remote activities. Managers of LTCF neglected the functionality of residents. Thus, health surveillance, prevention, and care must be reinforced for this population.
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7
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Wiseman L, Isbel S, Boag A, Halpin-Healy C, Gibson D, Bail K, Noble JM, D'Cunha NM. Online gallery facilitated art activities for people with dementia during the COVID-19 pandemic and beyond: A narrative review. DEMENTIA 2023; 22:1950-1976. [PMID: 37647250 PMCID: PMC10644691 DOI: 10.1177/14713012231198748] [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: 09/01/2023]
Abstract
Art activities for people with dementia have a range of therapeutic benefits including psychosocial wellbeing and enhanced quality of life. Successful art programs promote social engagement, are inclusive and empowering, and enable opportunity for people with dementia to express themselves verbally and non-verbally. The COVID-19 pandemic and associated social distancing precautions have impacted the capacity of art galleries and museums to deliver in-person programs. However, they have also provided a new opportunity. This paper explores the potential benefits, challenges, and future directions for research relating to the online delivery of gallery-facilitated art activities for people with dementia. The evidence revealed that increased digitisation of programs increased access for participants, however, the majority of the research was published before the pandemic. Nevertheless, COVID-19 has necessitated many museums and galleries to engage with people with dementia online. Future research is needed to improve the usability of online delivery platforms and a comparison of online and onsite delivery is recommended, particularly to evaluate benefits to people living in rural and remote areas where access to museums and galleries may be limited.
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Affiliation(s)
- Lara Wiseman
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Stephen Isbel
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Adriane Boag
- National Gallery of Australia, Parkes, ACT, Australia
| | | | - Diane Gibson
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Kasia Bail
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - James M Noble
- Arts and Minds, New York, NY, USA
- Taub Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathan M D'Cunha
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Frey R, Balmer D. Psychosocial well-being in Long-Term Care in the Wake of COVID-19: Findings from a Qualitative Study in New Zealand. J Cross Cult Gerontol 2023; 38:263-283. [PMID: 37466844 PMCID: PMC10447292 DOI: 10.1007/s10823-023-09485-3] [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] [Accepted: 07/15/2023] [Indexed: 07/20/2023]
Abstract
Drawing on Mason Durie's (1985) New Zealand Whare Tapa Whā model of health (spiritual, emotional, physical, and family domains), the goal was to link a model of well-being with the lived reality for long-term care residents and bereaved family members during COVID-19. Interviews were conducted with five residents and six family members of previous residents of one long-term care in one urban centre between July and September 2020. The increased demands imposed by the pandemic highlighted the gaps in well-being for residents and families. In particular, the inability to connect with family during COVID-19 restrictions reduced perceptions of well-being for residents. Study findings indicate that the provision of well-being for older adults and families in long-term care extends beyond the narrow bounds of the biomedical model. The Whare Tapa Whā model provides a valuable framework describing the holistic balance needed between the four health domains.
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Affiliation(s)
- Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand.
| | - Deborah Balmer
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
- Western Australian Centre for Rural Health (WACRH), University of Western Australia, Geraldton, Australia
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Lapane KL, Lim E, Mack DS, Hargraves JL, Cosenza C, Dubé CE. Rising to the Occasion: A National Nursing Home Study Documenting Attempts to Address Social Isolation During the COVID-19 Pandemic. J Am Med Dir Assoc 2023; 24:1127-1132.e6. [PMID: 37355245 PMCID: PMC10227205 DOI: 10.1016/j.jamda.2023.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES COVID-19-related policies introduced extraordinary social disruption in nursing homes. In response, nursing facilities implemented strategies to alleviate their residents' loneliness. This study sought to describe interventions nursing homes used, document the perceived effectiveness of efforts, and determine barriers to implementing strategies to mitigate social isolation and loneliness. DESIGN National survey of nursing homes sampled in strata defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5). SETTINGS AND PARTICIPANTS US Nursing Home Directors of Nursing/Administrators (n = 1676). METHODS The survey was conducted between February and May 2022 (response rate: 30%; n = 504, weighted n = 14,506). Weighted analyses provided nationally representative results. RESULTS One-third were extremely concerned about their home's ability to meet residents' medical and social needs during COVID-19 before vaccines were available and 13% after vaccines. Nearly all reported trying to mitigate residents' social isolation during the pandemic. Efforts tried, and perceived as most useful, included using technology (tablets, phones, emails), assigning staff as a family contact, and more staff time with residents. Most frequently cited barriers to implementation were related to staffing issues. CONCLUSIONS AND IMPLICATIONS Despite multiple challenges, nearly all nursing homes tried to implement many different approaches to address residents' social needs, with some (eg, having an assigned family contact, use of tablets and phones) perceived as more useful than others. Staffing issues presented barriers for addressing the social needs of nursing home residents. Many strategies for addressing social isolation placed more demands on a workforce already stretched to the limit. While concerns about resident social isolation reduced after vaccine availability, administrators remained extremely concerned about staff burnout and mental health.
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Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Emily Lim
- Department of Gerontology, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Deborah S Mack
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - J Lee Hargraves
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA; Center for Survey Research, University of Massachusetts Boston, Boston, MA, USA
| | - Carol Cosenza
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Catherine E Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Hung L, Hu G, Wong J, Ren H, Ahmed N, Hussein A, Young E, Berndt A, Mann J, Corepal R, Wong L. Telepresence Robots in Long-Term Care Settings in British Columbia
During the COVID-19 Pandemic: Analyzing the Experiences of Residents and Family
Members. Gerontol Geriatr Med 2023; 9:23337214231166208. [PMID: 37033088 PMCID: PMC10076606 DOI: 10.1177/23337214231166208] [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: 11/01/2022] [Revised: 02/10/2023] [Accepted: 03/09/2023] [Indexed: 04/07/2023] Open
Abstract
Telepresence robots are being increasingly used in long-term care (LTC) homes for
virtual visits between families and residents. This study investigated the
impacts and experiences of residents and their families using a telepresence
robot (Double 3) for 4 to 12 months during the COVID-19 pandemic. A total of 51
participants were recruited through purposive sampling, including 9 residents,
15 family members, and 27 staff from 4 LTC homes in British Columbia, Canada.
Conversational interviews were conducted with residents and family members.
Focus groups and one-to-one interviews were held with frontline staff. Thematic
analysis was performed, with five themes identified: (1) Stay connected, (2)
Regain autonomy, (3) Relieve caregiver burden, (4) Environmental and technical
issues, and (5) Scheduling concerns. In conclusion, telepresence robots helped
maintain social connections between residents and families, despite the COVID-19
restrictions.
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Affiliation(s)
- Lillian Hung
- University of British Columbia,
Vancouver, Canada
- Lillian Hung, Innovation in Dementia and
Aging Lab, Department of Nursing, University of British Columbia, T201-2211
Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
| | - Grace Hu
- University of British Columbia,
Vancouver, Canada
| | - Joey Wong
- University of British Columbia,
Vancouver, Canada
| | - Haopu Ren
- University of British Columbia,
Vancouver, Canada
| | - Nazia Ahmed
- University of British Columbia,
Vancouver, Canada
| | - Ali Hussein
- University of British Columbia,
Vancouver, Canada
| | - Erika Young
- University of British Columbia,
Vancouver, Canada
| | | | - Jim Mann
- University of British Columbia,
Vancouver, Canada
| | - Rekesh Corepal
- Alzheimer Society of British Columbia,
Vancouver, Canada
| | - Lily Wong
- University of British Columbia,
Vancouver, Canada
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Hung L, Lake C, Hussein A, Wong J, Mann J. Using telepresence robots as a tool to engage patient and family partners in dementia research during COVID-19 pandemic: a qualitative participatory study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:12. [PMID: 36959683 PMCID: PMC10035490 DOI: 10.1186/s40900-023-00421-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Long-term care (LTC) settings have been disproportionately affected by the COVID-19 pandemic; it is important to address unmet needs and explore practical strategies for supporting LTC residents and staff. The involvement of patient partners and family community members in research planning, implementation and evaluation is the basis of Patient and Public Involvement approach and has been challenging during the COVID-19 pandemic, as visitation restrictions have created barriers to conducting research in healthcare settings. Innovative methods and tools are needed for conducting participatory research. This study investigated the use of telepresence as innovative tools for participatory research based on three projects conducted with patient and family partners during the COVID-19 pandemic. METHODS The data source includes (a) team reflective discussions, (b) weekly meeting notes, (c) field notes, and (d) interviews with ten researchers. We applied purposive sampling to select ten researchers who used a telepresence robot to conduct research in British Columbia, Canada. Semi-structured one-to-one interviews were conducted via Zoom virtual meetings. Patient and family partners contributed to team analysis to identify themes. RESULTS Analysis of the data produced five themes: (1) Research Enabler, (2) User-Friendly Technology, (3) Increased Engagement, (4) Lack of Infrastructure and Resources, and (5) Training and Technical Obstacles. Based on the results, we propose "ROBOT"-an acronym for five actionable recommendations to support the use of telepresence robots for research. The ROBOT recommendations represent: Realign to adapt, Organize with champions, Blend strategies, Offer timely technical assistance, and Tailor training to individual needs. CONCLUSIONS This study offers practical insights into the use of telepresence robots as a safe and innovative tool for conducting remote research with people with dementia, even in times of restricted access, as with COVID-19. Future research should apply more creativity and flexibility in adopting technology to expand possibilities for involving people with dementia in research.
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Affiliation(s)
- Lillian Hung
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Charlie Lake
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Ali Hussein
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Joey Wong
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Jim Mann
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
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Hung L, Mann J, Wallsworth C, Upreti M, Kan W, Temirova A, Wong KLY, Ren H, To-Miles F, Wong J, Lee C, Kar Lai So D, Hardern S. Facilitators and Barriers to Using Virtual Reality and its Impact on Social Engagement in Aged Care Settings: A Scoping Review. Gerontol Geriatr Med 2023; 9:23337214231166355. [PMID: 37020921 PMCID: PMC10068985 DOI: 10.1177/23337214231166355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 04/03/2023] Open
Abstract
Aim: This scoping review aims to identify the facilitators and barriers to the implementation of VR technology in the aged-care setting. Background: Virtual reality (VR) offers the potential to reduce social isolation and loneliness through increased social engagement in aged-care settings. Methods and Analysis: This scoping review followed the Joanna Briggs Institute scoping review methodology and took place between March and August 2022. The review included a three-step search strategy: (1) identifying keywords from CINHAL, Embase, Medline, PsycInfo, Scopus, and Web of Science (2) conducting a second search using all identified keywords and index terms across selected databases; and (3) searching the reference lists of all included articles and reports for additional studies. Results: The final review included 22 articles. The analysis identified factors affecting the VR technology implementation in aged care settings to reduce isolation and loneliness: (a) key facilitators are local champions and staff training. (b) barriers include technological adaptability, video quality, and organizational culture. Conclusion: Existing evidence points to VR as a promising intervention to decrease loneliness and feelings of isolation and improve social engagement in older people living in aged-care settings.
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Affiliation(s)
- Lillian Hung
- University of British Columbia, Vancouver, Canada
| | - Jim Mann
- University of British Columbia, Vancouver, Canada
| | | | - Mona Upreti
- University of British Columbia, Vancouver, Canada
| | - Winnie Kan
- University of British Columbia, Vancouver, Canada
| | | | | | - Haopu Ren
- University of British Columbia, Vancouver, Canada
| | | | - Joey Wong
- University of British Columbia, Vancouver, Canada
| | - Caitlin Lee
- University of British Columbia, Vancouver, Canada
| | | | - Sonia Hardern
- Vancouver Coastal Health Authority, Regional Practice Lead, Research & Knowledge Translation (LTC-QI)
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Chu CH, Yee AV, Stamatopoulos V. “It’s the worst thing I’ve ever been put through in my life”: the trauma experienced by essential family caregivers of loved ones in long-term care during the COVID-19 pandemic in Canada. Int J Qual Stud Health Well-being 2022; 17:2075532. [PMID: 35638169 PMCID: PMC9176373 DOI: 10.1080/17482631.2022.2075532] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Essential family caregivers (EFCs) of relatives living in long-term care homes (LTCHs) experienced restricted access to their relatives due to COVID-19 visitation policies. Residents’ experiences of separation have been widely documented; yet, few have focused on EFCs’ traumatic experiences during the pandemic. Objective: This study aims to explore the EFCs’ trauma of being locked out of LTCHs and unable to visit their loved ones in-person during COVID-19. Methods Seven online focus groups with a total of 30 EFCs from Ontario and British Columbia, Canada were conducted as part of a larger mixed-method study. We used an inductive approach to thematic analysis to understand the lived experiences of trauma. Results Four trauma-related themes emerged: 1) trauma from prolonged separation from loved ones; 2) trauma from uncompassionate interactions with the LTCH’s staff and administrators; 3) trauma from the inability to provide care to loved ones, and 4) trauma from experiencing prolonged powerlessness and helplessness. Discussion The EFCs experienced a collective trauma that deeply impacted their relationships with their relatives as well as their perception of the LTC system. Experiences endured by EFCs highlighted policy and practice changes, including the need for trauma-centred approaches to repair relational damage and post-pandemic decision-making that collaborates with EFCs.
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Affiliation(s)
- Charlene H. Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Amanda V. Yee
- Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Stamatopoulos
- Faculty of Social Science and Humanities, Ontario Tech University, Oshawa, Ontario, Canada
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14
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Johansson-Pajala RM, Alam M, Gusdal A, Heideken Wågert PV, Löwenmark A, Boström AM, Hammar LM. Anxiety and loneliness among older people living in residential care facilities or receiving home care services in Sweden during the COVID-19 pandemic: a national cross-sectional study. BMC Geriatr 2022; 22:927. [PMID: 36456904 PMCID: PMC9714409 DOI: 10.1186/s12877-022-03544-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Older people were subjected to significant restrictions on physical contacts with others during the COVID-19 pandemic. Social distancing impacts older people's experiences of anxiety and loneliness. Despite a large body of research on the pandemic, there is little research on its effects on older people in residential care facilities (RCF) and in home care services (HCS), who are the frailest of the older population. We aimed to investigate the effect of the first wave of the COVID-19 pandemic in March-May 2020 on experiences of anxiety and loneliness among older people living in RCF or receiving HCS and the impact of the progression of the pandemic on these experiences. METHODS A retrospective cross-sectional design using data from the national user satisfaction survey (March - May 2020) by the Swedish National Board of Health and Welfare. Survey responses were retrieved from 27,872 older people in RCF (mean age 87 years) and 82,834 older people receiving HCS (mean age 84 years). Proportional-odds (cumulative logit) model was used to estimate the degree of association between dependent and independent variables. RESULTS Loneliness and anxiety were more prevalent among the older persons living in RCF (loneliness: 69%, anxiety: 63%) than those receiving HCS (53% and 47%, respectively). Proportional odds models revealed that among the RCF and HCS respondents, the cumulative odds ratio of experiencing higher degree of anxiety increased by 1.06% and 1.04%, respectively, and loneliness by 1.13% and 1.16%, respectively, for 1% increase in the COVID-19 infection rate. Poor self-rated health was the most influential factor for anxiety in both RCF and HCS. Living alone (with HCS) was the most influential factor affecting loneliness. Experiences of disrespect from staff were more strongly associated with anxiety and loneliness in RCF than in HCS. CONCLUSION Older people in RCF or receiving HCS experienced increasing levels of anxiety and loneliness as the first wave of the pandemic progressed. Older people' mental and social wellbeing should be recognized to a greater extent, such as by providing opportunities for social activities. Better preparedness for future similar events is needed, where restrictions on social interaction are balanced against the public health directives.
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Affiliation(s)
- Rose-Marie Johansson-Pajala
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Moudud Alam
- grid.411953.b0000 0001 0304 6002School of Information and Engineering/Statistics, Dalarna University, Falun, Sweden
| | - Annelie Gusdal
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Petra von Heideken Wågert
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Annica Löwenmark
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Anne-Marie Boström
- grid.4714.60000 0004 1937 0626Division of Nursing, Department of Neurobiology, Care Science and Society Karolinska Institute, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden ,grid.4714.60000 0004 1937 0626R&D unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Lena Marmstål Hammar
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden ,grid.4714.60000 0004 1937 0626Division of Nursing, Department of Neurobiology, Care Science and Society Karolinska Institute, Stockholm, Sweden ,grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden
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15
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“We’ve All Lost So Much”: The Long-Term Care Home Experiences of Essential Family Caregivers During COVID-19. Can J Aging 2022; 42:284-296. [PMID: 36384854 DOI: 10.1017/s0714980822000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
During the coronavirus (COVID-19) pandemic, long-term care homes (LTCHs) imposed visitor restrictions that prevented essential family caregivers (EFCs) from entering the homes. Under these policies, EFCs had to engage in virtual, window, and outdoor visits, prior to the re-initiation of indoor visits.
Objective
To understand EFCs’ visitation experiences with LTCH residents during COVID-19.
Methods
Seven virtual focus groups with EFCs were conducted and analysed using a thematic approach.
Findings
Six themes were identified: (a) inconsistent and poor communication; (b) lack of staffing and resources; (c) increasing discord between EFCs and staff during COVID-19; (d) shock related to reunification; (e) lack of a person-centred or family-centred approach; and, (f) EFC and resident relationships as collateral damage.
Discussion
Our findings reflect how EFCs’ visitation experiences were affected by factors at the individual, LTCH, and health-system levels. Future sectoral responses and visitation guidelines should recognize EFCs as an integral part of the care team.
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16
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van Dam K, Gielissen M, Reijnders R, van der Poel A, Boon B. Experiences of Persons With Executive Dysfunction in Disability Care Using a Social Robot to Execute Daily Tasks and Increase the Feeling of Independence: Multiple-Case Study. JMIR Rehabil Assist Technol 2022; 9:e41313. [PMID: 36326800 PMCID: PMC9672999 DOI: 10.2196/41313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/06/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Background Executive functions are essential for independently navigating nearly all of our daily activities. Executive dysfunction often occurs as a result of a neurodevelopmental disorder. Persons with executive dysfunction experience challenges regarding independent execution of daily tasks. Social robots might support persons with executive dysfunction to execute daily tasks and promote their feeling of independence. Objective This study aimed to study the impact of interacting with social robot Tessa on goal attainment in the execution of daily tasks and perceived independence of persons with executive dysfunction. Methods In this multiple-case study, 18 participant–caregiver couples were followed up while using Tessa in the home environment for 3 months. Goal attainment on independently performing a self-determined goal was measured by the Goal Attainment Scale, and participant–caregiver couples were interviewed about their experience with their interaction with Tessa and how they perceived Tessa’s impact on their independence. Results In total, 11 (61%) participants reached their goal after 6 weeks and maintained their goal after 3 months. During the study period, 2 participant–caregiver couples withdrew because of mismatch with Tessa. Participants set goals in the following domains: execution of household tasks; intake of food, water, or medication; being ready in time for an appointment; going to bed or getting out of bed on time; personal care; and exercise. Participants perceived that Tessa increased the feeling of independence by generating more structure, stimulation, and self-direction. Participant–caregiver couples reported that the auditive information provided by Tessa was more effective in coping with executive dysfunction compared to their initial approaches using visual information, and the use of Tessa had a positive impact on their relationship. Conclusions This study paid ample time and attention to the implementation of a social robot in daily care practice. The encouraging findings support the use of social robot Tessa for the execution of daily tasks and increasing independence of persons with executive dysfunction in disability care.
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Affiliation(s)
| | | | | | | | - Brigitte Boon
- Academy Het Dorp, Arnhem, Netherlands
- Siza, Arnhem, Netherlands
- Tranzo, Tilburg University, Tilburg, Netherlands
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17
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Perez H, Miguel-Cruz A, Daum C, Comeau AK, Rutledge E, King S, Liu L. Technology Acceptance of a Mobile Application to Support Family Caregivers in a Long-Term Care Facility. Appl Clin Inform 2022; 13:1181-1193. [PMID: 36257602 PMCID: PMC9771689 DOI: 10.1055/a-1962-5583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Family caregivers are unpaid individuals who provide care to people with chronic conditions or disabilities. Family caregivers generally do not have formal care-related training. However, they are an essential source of care. Mobile technologies can benefit family caregivers by strengthening communication with care staff and supporting the monitoring of care recipients. OBJECTIVE We conducted a mixed-method study to evaluate the acceptance and usability of a mobile technology called the Smart Care System. METHODS Using convenience sampling, we recruited 27 family caregivers to evaluate the mobile Smart Care System (mSCS). In the quantitative phase, we administered initial and exit questionnaires based on the Unified Theory of Acceptance and Use of Technology. In the qualitative phase, we conducted focus groups to explore family caregivers' perspectives and opinions on the usability of the mSCS. With the quantitative data, we employed univariate, bivariate, and partial least squares analyses, and we used content analysis with the qualitative data. RESULTS We observed a high level of comfort using digital technologies among participants. On average, participants were caregivers for an average of 6.08 years (standard deviation [SD] = 6.63), and their mean age was 56.65 years (SD = 11.62). We observed a high level of technology acceptance among family caregivers (7.69, SD = 2.11). Behavioral intention (β = 0.509, p-value = 0.004) and facilitating conditions (β = 0.310, p-value = 0.049) were statistically significant and related to usage behavior. In terms of qualitative results, participants reported that the mobile application supported care coordination and communication with staff and provided peace of mind to family caregivers. CONCLUSION The technology showed high technology acceptance and intention to use among family caregivers in a long-term care setting. Facilitating conditions influenced acceptance. Therefore, it would be important to identify and optimize these conditions to ensure technology uptake.
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Affiliation(s)
- Hector Perez
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Antonio Miguel-Cruz
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
- Faculty of Rehabilitation Medicine, University of Alberta. Edmonton, Alberta, Canada
- Glenrose Rehabilitation Research, Innovation & Technology (GRRIT) Hub, Glenrose Rehabilitation Hospital. Edmonton, Alberta, Canada
| | - Christine Daum
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
- Faculty of Rehabilitation Medicine, University of Alberta. Edmonton, Alberta, Canada
| | - Aidan K. Comeau
- Faculty of Rehabilitation Medicine, University of Alberta. Edmonton, Alberta, Canada
| | - Emily Rutledge
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Sharla King
- Faculty of Education, University of Alberta. Edmonton, Alberta, Canada
| | - Lili Liu
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
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18
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Chu CH, Quan AML, Gandhi F, McGilton KS. Perspectives of substitute decision-makers and staff about person-centred physical activity in long-term care. Health Expect 2022; 25:2155-2165. [PMID: 34748256 PMCID: PMC9615080 DOI: 10.1111/hex.13381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/03/2021] [Accepted: 10/17/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION This paper aims to explore the care processes that best exemplify person-centred care during physical activity (PA) for long-term care (LTC) residents with dementia from the perspectives of substitute decision-makers (SDMs) and LTC home staff. Little is known about how person-centred care is reflected during PA for residents with dementia, or the barriers and benefits to enacting person-centred care during PA. METHODS Semistructured interviews were used to collect SDMs and LTC home staffs' perspectives on the importance of person-centred care during PA from two LTC homes in Canada. The McCormack and McCance person-centredness framework was used to guide thematic content analysis of responses. RESULTS SDM (n = 26) and staff (n = 21) identified actions categorized under the sympathetic presence or engagement care processes from the person-centredness framework as most reflecting person-centred care. Benefits of person-centred care during PA were categorized into three themes: functional and physical, behavioural and communication and psychosocial improvements. Barriers to person-centred care during PA identified were lack of time, opportunities for meaningful activity in LTC setting and staff experiences with resident aggression. SIGNIFICANCE Understanding the care processes that are most recognized as person-centred care and valued by SDMs and LTC home staff has implications for education and training. Insights into SDMs' care expectations regarding person-centred care can inform staff about which actions should be prioritized to meet care expectations and can foster relationships to the benefit of residents with dementia. PATIENT AND PUBLIC CONTRIBUTION Study participants were not involved in the development of research questions, research design or outcome measures of this study.
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Affiliation(s)
- Charlene H. Chu
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
- Institute for Life Course and AgingUniversity of TorontoTorontoOntarioCanada
- KITE‐Toronto Rehabilitation InstituteUniversity Health Network TorontoTorontoOntarioCanada
| | - Amanda M. L. Quan
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Freya Gandhi
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
| | - Katherine S. McGilton
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
- KITE‐Toronto Rehabilitation InstituteUniversity Health Network TorontoTorontoOntarioCanada
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19
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Bin Noon G, Hanjahanja-Phiri T, Dave H, Fadrique LX, Morita PP, Teague J. Exploring the Role of Active Assisted Living in the Continuum of Care for Older Adults: Thematic Analysis (Preprint). JMIR Aging 2022; 6:e40606. [DOI: 10.2196/40606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/30/2023] [Accepted: 03/05/2023] [Indexed: 03/07/2023] Open
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20
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Hicks B, Karim A. Care home practitioners’ perceptions of the barriers and facilitators for using off-the-shelf gaming technology with people with dementia. DEMENTIA 2022; 21:1532-1555. [PMID: 35427198 PMCID: PMC9237851 DOI: 10.1177/14713012221085229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Off-the-shelf digital gaming technology has been shown to support the well-being of people with dementia. Yet, to date, it is rarely adopted within dementia care practice, particularly within care homes. Drawing on a descriptive, qualitative approach, this is the first study that has sought to explore care home practitioners’ perceptions of the barriers and facilitators for using gaming technology within their workplace. Method: Data were collected across eight focus groups in the south of England with a total of 39 care home workers. These were analysed inductively following the 6-stage thematic process as outlined by Braun and Clarke (2006). Findings: Three themes, constructed from the data suggested, the care environment, staff knowledge and skills for inclusive gaming, and staff perceptions about capabilities (their own and those of people with dementia) inhibited or facilitated the use of gaming technology in care homes. The findings were interpreted through a combination of the Capability, Opportunity, Motivation and Behaviour model and the Theoretical Domains Framework to provide theory-based insights into the mechanisms for supporting behaviour change and implementation within the care home context. Conclusions: We argue for the need to target wider institutional barriers alongside providing inclusive training for care staff on incorporating gaming technology within their person-centred care approaches. Through these mechanisms, they can be provided with the capabilities, opportunities and motivation to integrate gaming technology within their practice, and thus facilitate the process of culture change within care homes.
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Affiliation(s)
- Ben Hicks
- Ben Hicks, Brighton and Sussex Medical School, Centre for Dementia Studies, University of Sussex, Trafford Centre, Falmer Campus, Brighton BN1 9RY, UK.
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21
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Chu CH, Yee A, Stamatopoulos V. Poor and Lost Connections: Essential Family Caregivers' Experiences Using Technology with Family Living in Long-Term Care Homes during COVID-19. J Appl Gerontol 2022; 41:1547-1556. [PMID: 35416076 PMCID: PMC9014337 DOI: 10.1177/07334648221081850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Long-term care homes (LTCHs) restricted essential family caregivers’ (EFCs) visitations during COVID-19, and virtual visits using technology were used. Objective: To understand EFCs’ virtual visitations experiences during COVID-19 in two Canadian provinces. Methods: Seven focus groups were conducted with EFCs. Thematic analysis was used to identify themes at micro, meso, and macro levels. Results: Four themes were found: 1) a lack of technology and infrastructure; 2) barriers to scheduling visitations; 3) unsuitable technology implementation; and 4) inability of technology to adapt to residents’ needs. Discussion: Virtual visitations showcased a confluence of micro, meso, and macro factors that, in some cases, negatively impacted the EFCs, residents, and the relationship between EFCs and residents. Structural and home inequities within and beyond the LTCH impacted the quality of technology-based visitations, underscoring the need to support technology infrastructure and training to ensure residents are able to maintain relationships during visitation bans. Conclusion: EFCs’ experiences of technology-based visitations were impacted by structural vulnerabilities of the LTCH sector.
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Affiliation(s)
- Charlene H Chu
- 70379Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Institute of Institute for Life Course & Aging, 7938University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Amanda Yee
- Faculty of Arts and Science, 7938University of Toronto, Toronto, ON, Canada
| | - Vivian Stamatopoulos
- Faculty of Social Science and Humanities, 85458Ontario Tech University, Oshawa, ON, Canada
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22
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Noten S, Stoop A, De Witte J, Landeweer E, Vinckers F, Hovenga N, van Boekel LC, Luijkx KG. "Precious Time Together Was Taken Away": Impact of COVID-19 Restrictive Measures on Social Needs and Loneliness from the Perspective of Residents of Nursing Homes, Close Relatives, and Volunteers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3468. [PMID: 35329154 PMCID: PMC8950639 DOI: 10.3390/ijerph19063468] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022]
Abstract
During the COVID-19 outbreak in March 2020, restrictive measures (e.g., prohibiting physical visits and group activities) were introduced in nursing homes to protect older residents. Although the importance of social contacts and social activities to fulfill social needs and avoid loneliness is known, these were challenged during the pandemic. This qualitative study specifically focused on how residents, close relatives, and volunteers in nursing homes experienced the restrictive measures in retrospect and gained insights into the impact of the restrictive measures on social needs and loneliness, and the lessons that could be learned. Thirty semi-structured, face-to-face interviews with residents and close relatives, and one online focus group with ten volunteers, were conducted. Recruitment took place at psychogeriatric and somatic units in the Northern, Eastern and Southern regions of the Netherlands and Flanders, Belgium. The interviews and focus group were transcribed verbatim, and an open, inductive approach was used for analysis. Alternative ways of social contact could not fully compensate for physical visits. Generally, participants reported that it was a difficult time, indicated by feelings of loneliness, fear, sadness, and powerlessness. A great diversity in loneliness was reported. The most important reasons for feeling lonely were missing close social contacts and social activities. The diversity in the impact of restrictive measures depended on, e.g., social needs, coping strategies, and character. Restrictive COVID-19 measures in nursing homes resulted in negative emotions and unmet social needs of residents, close relatives, and volunteers. During future outbreaks of the COVID-19 virus or another virus or bacterium, for which restrictive measures may be needed, nursing homes should actively involve residents, close relatives, and volunteers to balance safety, self-determination, and well-being.
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Affiliation(s)
- Suzie Noten
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; (S.N.); (K.G.L.)
| | - Annerieke Stoop
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; (S.N.); (K.G.L.)
| | - Jasper De Witte
- HIVA—Research Institute for Work and Society KU Leuven, P.O. Box 5300, 3000 Leuven, Belgium;
| | - Elleke Landeweer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.L.); (F.V.); (N.H.)
| | - Floor Vinckers
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.L.); (F.V.); (N.H.)
| | - Nina Hovenga
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.L.); (F.V.); (N.H.)
| | - Leonieke C. van Boekel
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, 4819 EV Breda, The Netherlands;
| | - Katrien G. Luijkx
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; (S.N.); (K.G.L.)
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Miguel Cruz A, Lopez Portillo HP, Daum C, Rutledge E, King S, Liu L. Technology Acceptance and Usability of a Mobile Application to Support the Workflow of Health Care Aides who Provide Services to older adults residing in a care facility: A Pilot Mixed Methods Study (Preprint). JMIR Aging 2022; 5:e37521. [PMID: 35583930 PMCID: PMC9161048 DOI: 10.2196/37521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 01/01/2023] Open
Abstract
Background Health care aides are unlicensed support personnel who provide direct care, personal assistance, and support to people with health conditions. The shortage of health care aides has been attributed to recruitment challenges, high turnover, an aging population, the COVID-19 pandemic, and low retention rates. Mobile apps are among the many information communication technologies that are paving the way for eHealth solutions to help address this workforce shortage by enhancing the workflow of health care aides. In collaboration with Clinisys EMR Inc, we developed a mobile app (Mobile Smart Care System [mSCS]) to support the workflow of health care aides who provide services to older adult residents of a long-term care facility. Objective The purpose of this study was to investigate the technology acceptance and usability of a mobile app in a real-world environment, while it is used by health care aides who provide services to older adults. Methods This pilot study used a mixed methods design: sequential mixed methods (QUANTITATIVE, qualitative). Our study included a pre– and post–paper-based questionnaire with no control group (QUAN). Toward the end of the study, 2 focus groups were conducted with a subsample of health care aides (qual, qualitative description design). Technology acceptance and usability questionnaires used a 5-point Likert scale ranging from disagree (1) to agree (5). The items included in the questionnaires were validated in earlier research as having high levels of internal consistency for the Unified Theory of Acceptance and Use of Technology constructs. A total of 60 health care aides who provided services to older adults as part of their routine caseloads used the mobile app for 1 month. Comparisons of the Unified Theory of Acceptance and Use of Technology constructs’ summative scores at pretest and posttest were calculated using a paired t test (2-tailed). We used the partial least squares structural regression model to determine the factors influencing mobile app acceptance and usability for health care aides. The α level of significance for all tests was set at P≤.05 (2-tailed). Results We found that acceptance of the mSCS was high among health care aides, performance expectancy construct was the strongest predictor of intention to use the mSCS, intention to use the mSCS predicted usage behavior. The qualitative data support the quantitative findings and showed health care aides’ strong belief that the mSCS was useful, portable, and reliable, although there were still opportunities for improvement, especially with regard to the mSCS user interface. Conclusions Overall, these results support the assertion that mSCS technology acceptance and usability are high among health care aides. In other words, health care aides perceived that the mSCS assisted them in addressing their workflow issues.
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Affiliation(s)
- Antonio Miguel Cruz
- Glenrose Rehabilitation Research, Innovation & Technology, Glenrose Rehabilitation Hospital, Edmoton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | | | - Christine Daum
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Emily Rutledge
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Sharla King
- Educational Psychology, Faculty of Education, Edmonton, AB, Canada
| | - Lili Liu
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
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Iaboni A, Quirt H, Engell K, Kirkham J, Stewart S, Grigorovich A, Kontos P, McMurray J, Levy A, Bingham K, Rodrigues K, Astell A, Flint AJ, Maxwell C. Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit. BMC Geriatr 2022; 22:74. [PMID: 35078424 PMCID: PMC8786624 DOI: 10.1186/s12877-022-02759-4] [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: 08/12/2021] [Accepted: 01/05/2022] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background
People working in long-term care homes (LTCH) face difficult decisions balancing the risk of infection spread with the hardship imposed on residents by infection control and prevention (ICP) measures. The Dementia Isolation Toolkit (DIT) was developed to address the gap in ethical guidance on how to safely and effectively isolate people living with dementia while supporting their personhood. In this observational study, we report the results of a survey of LTCH staff on barriers and facilitators regarding isolating residents, and the impact of the DIT on staff moral distress.
Methods
We completed an online cross-sectional survey. Participants (n = 207) were staff working on-site in LTCH in Ontario, Canada since March 1, 2020, with direct or indirect experience with the isolation of residents. LTCH staff were recruited through provincial LTCH organizations, social media, and the DIT website. Survey results were summarized, and three groups compared, those: (1) unfamiliar with, (2) familiar with, and (3) users of the DIT.
Results
61% of respondents identified distress of LTCH staff about the harmful effects of isolation on residents as a major barrier to effective isolation. Facilitators for isolation included delivery of 1:1 activity in the resident’s room (81%) and designating essential caregivers to provide support (67%). Almost all respondents (84%) reported an increase in moral distress. DIT users were less likely to report an impact of moral distress on job satisfaction (odds ratio (OR) 0.41, 95% CI 0.19-0.87) with 48% of users reporting the DIT was helpful in reducing their level of moral distress.
Conclusions
Isolation as an ICP measure in LTCH environments creates moral distress among staff which is a barrier to its effectiveness. ICP guidance to LTCH would be strengthened by the inclusion of a dementia-specific ethical framework that addresses how to minimize the harms of isolation on both residents and staff.
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Vellani S, Zuniga F, Spilsbury K, Backman A, Kusmaul N, Scales K, Chu CH, Mateos JT, Wang J, Fagertun A, McGilton KS. Who's in the House? Staffing in Long-Term Care Homes Before and During COVID-19 Pandemic. Gerontol Geriatr Med 2022; 8:23337214221090803. [PMID: 35529694 PMCID: PMC9073116 DOI: 10.1177/23337214221090803] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Critical gaps exist in our knowledge on how best to provide quality person-centered care to long-term care (LTC) home residents which is closely tied to not knowing what the ideal staff is complement in the home. A survey was created on staffing in LTC homes before and during the COVID-19 pandemic to determine how the staff complement changed. Perspectives were garnered from researchers, clinicians, and policy experts in eight countries and the data provides a first approximation of staffing before and during the pandemic. Five broad categories of staff working in LTC homes were as follows: (1) those responsible for personal and support care, (2) nursing care, (3) medical care, (4) rehabilitation and recreational care, and (5) others. There is limited availability of data related to measuring staff complement in the home and those with similar roles had different titles making it difficult to compare between countries. Nevertheless, the survey results highlight that some categories of staff were either absent or deemed non-essential during the pandemic. We require standardized high-quality workforce data to design better decision-making tools for staffing and planning, which are in line with the complex care needs of the residents and prevent precarious work conditions for staff.
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Affiliation(s)
- Shirin Vellani
- Faculty of Health Sciences, School of Nursing, Health Sciences Centre, McMaster University, Hamilton, ON, Canada
| | - Franziska Zuniga
- Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Karen Spilsbury
- Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds, UK
| | | | - Nancy Kusmaul
- School of Social Work, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Kezia Scales
- Paraprofessional Healthcare Institute, Bronx, NY, USA
| | - Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - José Tomás Mateos
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Jing Wang
- Fudan University School of Nursing, Shanghai, China
| | - Anette Fagertun
- Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway
| | - Katherine S McGilton
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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26
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Hung L, Mann J, Perry J, Berndt A, Wong J. Technological risks and ethical implications of using robots in long-term care. J Rehabil Assist Technol Eng 2022; 9:20556683221106917. [PMID: 35733613 PMCID: PMC9208036 DOI: 10.1177/20556683221106917] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The pandemic provides a unique opportunity to examine new directions in innovative technological approaches in long-term care (LTC) homes. While robotics could enhance staff capacity to provide care, there are potential technology risks and ethical concerns involved in technology use among older people residing in communal aged care homes. This qualitative descriptive study explores the technological risks and ethical issues associated with the adoption of robots in the specific context of LTC homes. Methods The research team including patient and family partners employed purposive and snowballing methods to recruit 30 LTC participants: frontline interdisciplinary staff, operational leaders, residents and family members, and ethics experts in dementia care. Semi-structured interviews were conducted. Thematic analysis was performed to identify themes that capture empirical experiences and perspectives of a diverse group of LTC stakeholders about robotic use. Results Technological risks include safety, increased workload, privacy, cost and social justice, and human connection. The findings offer practical insights based on the LTC perspective to contribute to the robot ethics literature. We propose a list of pragmatic recommendations, focusing on six principles (ETHICS): Engagement of stakeholders, Technology benefit and risk assessment, Harm mitigation, Individual autonomy, Cultural safety and justice, Support of privacy. Conclusions There is both a growing interest as well as fear in using robotics in LTC. Practice leaders need to reflect on ethical considerations and engage relevant stakeholders in making technology decisions for everyday care.
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Affiliation(s)
- Lillian Hung
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Jim Mann
- Community Engagement Advisory Network, Vancouver, BC, Canada
| | - Jennifer Perry
- Alzheimer Society of British Columbia, Vancouver, BC, Canada
| | - Annette Berndt
- Community Engagement Advisory Network, Vancouver, BC, Canada
| | - Joey Wong
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Xiao LD, Chen L, Han W, Meyer C, Müller A, Low LF, Brijnath B, Mohammadi L. Optimising social conditions to improve autonomy in communication and care for ethnic minority residents in nursing homes: A meta-synthesis of qualitative research. Nurs Inq 2021; 29:e12469. [PMID: 34647382 DOI: 10.1111/nin.12469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
A large proportion of nursing home residents in developed countries come from ethnic minority groups. Unmet care needs and poor quality of care for this resident population have been widely reported. This systematic review aimed to explore social conditions affecting ethnic minority residents' ability to exercise their autonomy in communication and care while in nursing homes. In total, 19 studies were included in the review. Findings revealed that ethno-specific nursing homes create the ideal social condition for residents to express their care needs and preferences in a language of choice. In nonethno-specific nursing homes, staff cultural competence and nursing home commitment to culturally safe care are crucial social conditions that enable this group of residents to fulfil their autonomy in communicating and in participating in their care. In contrast, social conditions that undermine residents' ability to express their care needs and preferences include low levels of staff cultural awareness and cultural desire, negative attitudes towards residents and limited organisational support for staff to improve culturally responsive and culturally safe care. In conclusion, it is important to optimise the social conditions to support ethnic minority residents to communicate their care needs and preferences.
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Affiliation(s)
- Lily D Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Li Chen
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Weifeng Han
- Speech Pathology, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia.,Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia.,Centre for Health Communication and Participation, La Trobe University, Melbourne, Victoria, Australia
| | - Amanda Müller
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Bianca Brijnath
- Social Gerontology, National Ageing Research Institute (NARI), Parkville, Melbourne, Victoria, Australia.,School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Leila Mohammadi
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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