Fulfilled preferences, perceived control, life satisfaction, and loneliness in elderly long-term care residents

Older adult supportive environment at home-a case study in Jordan: overall sense of control associated with home modification

Introduction

Modification becomes a critical issue in a supportive home environment for older adults.

Methods

This study examined if modifications in different spaces at home are facilitated to provide a supportive environment for older adults to feel in control in a cultural context. Data was utilized using field research with a mixed method design: Structured and open-ended interviews as well as surveys using a questionnaire. The hypothesis states that older adults have a supportive environment at home when the overall sense of control is associated with home modification.

Results

The result reveals that overall sense of control with home modification and its components: kitchen, bedroom, living room, and reception room have a significant effect on older adults' wellbeing.

Discussion

Therefore, older adult supported environment in Jordan can only take place by boosting awareness about the existing problems in the physical environment, by describing the benefits of home modification and by reducing the barriers of home modifications. This process can enhance the housing market and provide better urban policies for urban design and urban planning based on cultural heritage and values.

Understanding deep disadvantage at the end of life: A nationwide analysis of unclaimed deaths

OBJECTIVES

To describe unclaimed deaths nationwide and to examine contextual factors associated with higher rates of these types of interments.

METHODS

Unclaimed death records from 2009 to 2021 were collected by a combination of direct outreach and obtaining data from publicly available websites. Data were summarized by county-year and linked to American Community Survey demographic variables, as well as markers of social isolation and economic disadvantage.

RESULTS

The underlying individual-level dataset included 42,942 decedents. Unclaimed deaths in the United States from 2009 to 2021, based on data from more than 248 counties that provided records, are increasing over time. This population appears to be younger at death, more male, and more likely to be of Black race than decedents in the general population. Several county-level markers of social isolation and economic deprivation were correlates of unclaimed deaths.

CONCLUSIONS

This is the first systematic examination of unclaimed deaths at the county level and offers a novel way to understand marginalized populations, such as the unhoused and others living in extreme social or economic deprivation. Unclaimed death rates may also provide an objective measure of social support that can be measured over time.

Food-Related Control and Person-Centered Care: Influences on Life Satisfaction in Long-Term Care Residents

Upon entering long-term care (LTC) homes, residents relinquish control over their daily life choices, which may influence life satisfaction. This study explored hypothesized relationships among the concepts of person-centered care, locus of control (LOC), and life satisfaction of LTC residents. Survey data were collected and analyzed from 154 residents of 16 skilled nursing facilities in the Midwest. Data were analyzed using structural equation modeling to examine relationships among person-centered care, life satisfaction, food-related life satisfaction, health LOC and food-related control. Results indicated food-related life satisfaction was influenced by perceived person-centered care and life satisfaction. Health LOC and person-centered care affected life satisfaction. Support for the use of person-centered care practices was demonstrated in LTC. The results suggest that older adults in LTC should be encouraged to participate in food-related decision-making to support life satisfaction.

[Strategies against loneliness-examples from an international comparative perspective]

The extent of loneliness differs internationally. Especially in the developed welfare states of Northern Europe, loneliness levels in the population are comparatively low. However, the increase in loneliness in many countries shows that existing concepts are not sufficient to provide effective protection against loneliness. Younger people also need to be strengthened so that they do not withdraw when they experience social exclusion and loneliness. This requires qualified specialists in kindergartens, schools, sports clubs, and other leisure facilities who help children and young people to establish social contacts. Friendship and neighborhood models have proven to be successful when it comes to strategies to combat loneliness. Greater identification with the neighborhood and a feeling of security help build social networks and reduce loneliness. For older people it is important to be able to stay in their usual social environment and maintain their social contacts. To this end, accessible public spaces must be combined with home care and support services that are tailored to the needs and wishes of older people.

Effect of long-term care insurance on medical expenditure and health status: National cohort study

BACKGROUND

Long-term care insurance (LTCI) was implemented in China to solve the elderly care problems caused by the aging population. It is crucial to evaluate the effectiveness of LTCI implementation from the perspective of value-based healthcare.

OBJECTIVE

This study aimed to investigate the impact of LTCI on medical care expenditure and health status in China.

METHODS

We used staggered difference-in-differences (DID) analysis to analyze the effect of LTCI policy on medical expenditure and health status based on China Health and Retirement Longitudinal Study data from 2011 to 2018.

RESULTS

Our findings confirmed the positive contribution of LTCI policies to medical expenditures and health status. We found that the implementation of LTCI significantly reduced inpatient and outpatient expenditure, scores of self-report of health, and CESD scores by 26.3%, 12.3%, 0.103, and 0.538, respectively. It also decreased ADL scores, but the decrease was not significant. The impact of LTCI on reducing inpatient expenditure was greater for individuals aged between 65 and 80 and those residing in urban areas and eastern cities. In terms of outpatient costs, the effect of LTCI was more pronounced among median and high-income people and people living in central and eastern cities. The impact of LTCI on self-report of health is stronger for rural populations, individuals under 80, and those in central and eastern cities. For ADL scores, LTCI affected those aged 65-80 the most. About the CESD scores, LTCI had a greater impact on rural populations, people aged 45-65, median income groups, and those in eastern cities.

CONCLUSIONS

Our study underscored LTCI's effectiveness in curbing medical expenditures and enhancing health status, offering valuable insights for future LTCI development in China and beyond. Accelerating the development of LTCI is conducive to improving the quality of life of the disabled elderly, enhancing the well-being of people's livelihoods, and realizing the goal of value-based healthcare.

Development of the Food-Related Control Scale for Long-Term Care

OBJECTIVE

Develop and test a Food-Related Control Scale (FRCS) measuring resident-perceived control in long-term care food service.

DESIGN

A bank of 15 initial items based on a multidimensional locus of control construct was developed initially. Expert review, cognitive interviews, a pilot study, and factor analysis were used to validate the instrument and assess reliability.

SETTING

Individual phone-based cognitive interviews and 16 skilled nursing facilities in the US.

PARTICIPANTS

Cognitive interviews included a convenience sample of independently living adults aged ≥ 65 (n = 13), whereas the pilot study included skilled nursing facility-residing adults (n = 166).

VARIABLES MEASURED

Perception of food-related control in a long-term care setting.

ANALYSIS

Cognitive interviews were analyzed to develop items. Quantitative data from skilled nursing facility residents were analyzed using SAS software for structural equation modeling and factor analysis.

RESULTS

A 2-dimensional construct (9 items) of the FRCS demonstrated reliability with factor analysis. Concurrent validity within the locus of control construct was demonstrated with the Multidimensional Health Locus of Control Scale (standardized estimate of 0.430; P < 0.1).

CONCLUSIONS AND IMPLICATIONS

The FRCS may be used to determine how residents in long-term care perceive control over their food experiences. Further testing is necessary to determine the appropriateness of the FRCS for different population uses.

Mobile device accessibility with 3D printed devices for individuals with physical disabilities

PURPOSE

Disparities may disproportionately exist for those with disabilities when using mobile devices, which are critical for independence in activities such as socialization and leisure. Prior 3D printing studies in rehabilitation have not focused on mobile device access to everyday preferred activities.

METHODS

This study examined user satisfaction, self-rated performance and satisfaction with daily activities while using the mobile device, and the feasibility of customized 3D printed assistive devices. The design was a one-group, quantitative pre-test to post-test study of individuals (n = 10) residing in long-term care with a physical disability due to a neurological condition.

RESULTS

Satisfaction with the 3D printed device, as compared to the previously used assistive device, was significantly higher (p = 0.005), as well as improvements in self-rated daily activity performance (p = 0.016) and satisfaction (p = 0.037), with acceptability and satisfaction of the intervention.

CONCLUSIONS

Findings suggest that 3D printing is feasible with a potential increase in user satisfaction through a customization process that is client centred.

The mediating role of community identity in the relationship between social class and life satisfaction: Evidence from Chinese community residents

Research has shown that social class is an important predictor of life satisfaction. However, the underlying mechanism for this relationship is yet to be fully elucidated. The study examined the underlying mechanism based on the social identity approach to health. Study 1 recruited 577 community residents to complete self-report questionnaires. Correlation analysis showed that social class, community identity, and life satisfaction were positively correlated with each other. Regression analysis showed that community identity mediated the relationship. To increase the replicability and derive causal inference of the results, Study 2 was a randomized control trial (N = 76) that used the resource-availability task to manipulate subjective social class, and found that life satisfaction in the lower-class group was significantly lower than that in the control group. Further analysis showed that social class predicted life satisfaction through the mediating role of community identity. The findings provide potential strategies to enhance community residents' life satisfaction.

Caregiver interactions, perceived control, and meaning in life of elderly: the moderating effect of the elderly-to-social worker ratio

BACKGROUND

Meaning in life is a widely accepted aim in promoting psychosocial health in institutional care. However, how caregiver interaction and perceived control impact meaning in life among the elderly remains unclear. This study explores the effect of institutional caregiver interaction, family caregiver interaction, and perceived control on meaning in life among elderly residents in China, and the potential moderating effect of elderly-to-social worker ratio in these associations.

METHODS

Multistage random sampling was used to recruit a sample of 452 elderly residents from 4 elderly care homes in urban China. A structural equation model was used to test the study hypothesis.

RESULTS

Institutional caregiver interaction is positively related to meaning in life, and perceived control among elderly residents has a positive impact on meaning in life. Moreover, the elderly-to-social worker ratio moderated the relationship between institutional caregiver interaction and meaning in life, as well as between family caregiver interaction and meaning in life.

CONCLUSIONS

Increase elderly's meaning in life is an important service target for the caring professions in institutional care. Social workers affect the effectiveness of interventions on elderly's meaning in life in institutional care. A higher elderly-to-social worker ratio could improve the effectiveness of interventions on meaning in life for elderly residents.

The Mediating Role of Sense of Control in the Associations Between Remote Contacts and Loneliness Among Older Adults

This study explored whether a sense of control over social life mediated the associations between using remote contact (phone calls, letters/emails, social media) and loneliness for socially isolated older adults. We used path analysis with the 2014 and 2016 Health and Retirement Study datasets (N = 3767). Results showed that more frequent phone calls and letters/emails were associated with lower levels of loneliness through sense of control. However, sense of control did not mediate the association between social media and loneliness. Findings suggest that promoting sense of control over social life by remote contact, particularly phone calls and letters/emails, may be effective in alleviating loneliness for isolated older adults.

Middle-aged and older people's preference for medical-elderly care integrated institutions in China: a discrete choice experiment study

BACKGROUND

With the continuing impact of the aging population, medical-elderly care integrated institutions, as a way to bear the pressure of medical and elderly care, effectively ensure the quality of life of the elderly in their later years.

OBJECTIVES

To explore the preferences of medical-elderly care integrated institutions among Chinese middle-aged and older people and to provide a reference for establishing elderly-oriented development of medical-elderly care integrated institutions.

METHODS

In this study, a discrete choice experiment (DCE) was used to investigate the preferences of people aged 45 years and older in medical-elderly care integrated institutions in China from October 20, 2022, to November 10, 2022. A mixed logit regression model was used to analyze the DCE data. Participants' willingness to pay for each attribute was also calculated.

RESULTS

Data from 420 participants who provided valid responses were included in the analysis. In terms of the choice preference, moderate service quality (vs. poor service quality: β = 1.707, p < 0.001, 95% CI 1.343 ~ 2.071) and high medical technology level (vs. low medical technology level: β = 1.535, p < 0.001, 95% CI 1.240 ~ 1.830) were the most important attributes to middle-aged and older people, followed by monthly cost, environmental facilities, the convenience of transportation, and entertainment activities. Regarding the willingness to pay, participants were more willing to pay for service quality and medical technology level than for other attributes. They were willing to pay $3156 and $2838 more for "poor service quality" and "low medical technology level," respectively, to receive "moderate service quality " (p = 0.007, 95% CI 963 ~ 5349) and "high medical technology level" (p = 0.005, 95% CI 852 ~ 4824).

CONCLUSIONS

The state should attach great importance to the development of medical-elderly care integrated services industry, actively optimize the model of the medical-elderly care integrated service, improve the facilities, and create a healthy environment. At the same time, give full play to the role of medical insurance, long-term care insurance, and commercial insurance, so as to improve the comprehensive quality of life of the elderly.

PUBLIC CONTRIBUTION

The design of the experimental selection was guided by 10 experts in the field, 5 Chinese government officials, and interviews and focus group discussions, without whose participation this study would not have been possible.

Provincial policies affecting resident quality of life in Canadian residential long-term care

BACKGROUND

The precautions and restrictions imposed by the recent Covid-19 pandemic drew attention to the criticality of quality of care in long-term care facilities internationally, and in Canada. They also underscored the importance of residents' quality of life. In deference to the risk mitigation measures in Canadian long-term care settings during Covid-19, some person-centred, quality of life policies were paused, unused, or under-utilised. This study aimed to interrogate these existing but latent policies, to capture their potentiality in terms of positively influencing the quality of life of residents in long-term care in Canada.

METHODS

The study analysed policies related to quality of life of long-term care residents in four Canadian provinces (British Columbia, Alberta, Ontario, and Nova Scotia). Three policy orientations were framed utilising a comparative approach: situational (environmental conditions), structural (organisational content), and temporal (developmental trajectories). 84 long term care policies were reviewed, relating to different policy jurisdictions, policy types, and quality of life domains.

RESULTS

Overall, the intersection of jurisdiction, policy types, and quality of life domains confirms that some policies, particularly safety, security and order, may be prioritised in different types of policy documents, and over other quality of life domains. Alternatively, the presence of a resident focused quality of life in many policies affirms the cultural shift towards greater person-centredness. These findings are both explicit and implicit, and mediated through the expression of individual policy excerpts.

CONCLUSION

The analysis provides substantive evidence of three key policy levers: situations-providing specific examples of resident focused quality of life policy overshadowing in each jurisdiction; structures-identifying which types of policy and quality of life expressions are more vulnerable to dominance by others; and trajectories-confirming the cultural shift towards more person-centredness in Canadian long-term care related policies over time. It also demonstrates and contextualises examples of policy slippage, differential policy weights, and cultural shifts across existing policies. When applied within a resident focused, quality of life lens, these policies can be leveraged to improve extant resource utilisation. Consequently, the study provides a timely, positive, forward-facing roadmap upon which to enhance and build policies that capitalise and enable person-centredness in the provision of long-term care in Canada.

A Middle-Range Theory of Social Isolation in Chronic Illness

Chronic illnesses and social isolation are major public phenomena that drive health and social policy worldwide. This article describes a middle-range theory of social isolation as experienced by chronically ill individuals. Key concepts include social disconnectedness, loneliness, and chronic illness. Antecedents of social isolation include predisposing factors (e.g., ageism and immigration) and precipitating factors (e.g., stigma and grief). Outcomes of social isolation include psychosocial responses (e.g., depression and quality of life), health-related behaviors (i.e., self-care), and clinical responses (e.g., cognitive function and health service use). Possible patterns of social isolation in chronic illness are described.

Characteristics and value of 'meaningful activity' for people living with dementia in residential aged care facilities: "You're still part of the world, not just existing"

Most residential aged care facilities support residents to participate in activities and the importance of activities that are suited to individual preferences and abilities is widely acknowledged. Participating in activities, including those considered to be 'meaningful' has the potential to improve residents' quality of life. However, what makes activities meaningful for people living with dementia in residential aged care facilities is unclear. The aim of this study was to understand the key characteristics of 'meaningful activity' in residential aged care facilities and the perceived value of residents participating in these activities. Using a qualitative study design, this study explored 'meaningful activities' from the perspectives of people living with dementia in residential aged care facilities, their family members and staff. Across four residential aged care facilities, residents (n = 19) and family members (n = 17) participated in individual interviews while staff (n = 15) participated in focus group interviews. Interviews were recorded, transcribed and analysed using a qualitative content analysis approach. Participant responses suggest that the meaning of an activity is subjective, varying over time and between individuals. Key characteristics of an activity that makes it meaningful include being enjoyable, social and engaging, aligning with the persons' interests, preferences, and abilities. To be considered meaningful, activities need to do more than occupy the person. The activity needs to be linked to a personally relevant goal and an aspect of the individuals' identity. Participating in 'meaningful activities' was perceived as valuable to encourage participation and socialising, provide a sense of normality for residents and improve their wellbeing. The findings of this study further our understanding of the concept of 'meaningful activity' for people living with dementia in residential aged care facilities. Understanding the key attributes of 'meaningful activity' can also provide practical guidance for those supporting people with dementia to participate in these types of activities.

Exploring experiences of loneliness among Canadian long-term care residents during the COVID-19 pandemic: A qualitative study

BACKGROUND

The COVID-19 pandemic has significant impact on long-term care (LTC) residents' health and well-being.

OBJECTIVES

This study investigated resident experiences of loneliness during the COVID-19 pandemic in Canadian LTC homes to offer lessons learned and implications.

METHODS

15 residents and 16 staff members were recruited from two large urban Canadian LTC homes with large outbreaks and fatalities. We used a telepresence robot to conduct one-on-one semi-structured interviews with participants remotely. We applied the Collaborative Action Research (CAR) methodology and report the early phase of CAR focused on collecting data and reporting findings to inform actions for change. Thematic analysis was performed to identify themes.

RESULTS

Four themes were identified. The first two themes characterise what commonly generated feelings of loneliness amongst residents, including (1) social isolation and missing their family and friends and (2) feeling hopeless and grieving for lives lost. The second two themes describe what helped residents alleviate loneliness, including (3) social support and (4) creating opportunities for recreation and promoting positivity.

CONCLUSIONS

Residents living in LTC experienced significant social isolation and grief during the pandemic that resulted in loneliness and other negative health consequences.

IMPLICATIONS FOR PRACTICE

Promoting meaningful connection, safe recreational activities and a positive atmosphere in LTC homes during the pandemic may help mitigate residents' experiences of loneliness due to social isolation and/or grief and enhance their quality of life.

Association of unmet long-term care needs with depression and anxiety among older adults in urban and rural China

This study examined the association of unmet long-term care (LTC) needs with depression and anxiety in older adults and explored urban-rural disparities. Cross-sectional data for 1896 respondents with a mean age of 91.58 years was from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depression and anxiety were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Unmet LTC needs were self-reported by older adults with functional limitations. Research methods included regression analyses, decomposition analyses, sensitivity analyses. Results showed that unmet LTC needs, depression, anxiety were more severe in rural older adults. Unmet LTC needs were significantly and positively related to depression and anxiety, but their associations with CESD-10 scores, depressive and anxiety symptoms were stronger in urban older adults. Urban-rural disparities in unmet LTC needs explained about 20%-40% of disparities in depression and anxiety. The findings highlighted the role of meeting LTC needs in reducing depression and anxiety, and that LTC policymakers should not ignore the needs of urban older adults and focus solely on rural older adults.

Comparing Resident, Proxy, and Staff Respondents for Nursing Home Residents' Preferences for Everyday Living

To encourage person-centered care, the Centers for Medicare and Medicaid require nursing homes to measure resident preferences using the Preferences Assessment Tool (PAT). No known research has examined the implications of respondent type (i.e., resident, proxy, staff) on preference importance; therefore, the purpose of this study was to compare the importance of preferences depending on which respondent completed the PAT. Participants included 16,111 Veterans discharged to community-based skilled nursing facilities after hospitalization for heart failure. A majority (95%) of residents completed the PAT compared to proxy (3%) and staff (2%). Proxy responders were both more and less likely to indicate individual preferences as important compared to residents. Staff members were consistently less likely to indicate all preferences as important compared to residents. Findings from this study emphasize the need for proxy and staff to find methods to better understand residents' preferences when residents are not able to participate in assessments.

Autonomy and loneliness - longitudinal within- and between-person associations among Swedish older adults

OBJECTIVES

Loneliness is an important risk factor for mental and physical health over the life span. Little is known about psychosocial predictors and consequences of loneliness apart from social network characteristics. One important factor that may both prevent from, but also be affected by loneliness, is perceived autonomy.

METHOD

In the present study, we investigated the longitudinal association of loneliness and autonomy over four years among participants of the Swedish Health, Aging and Retirement Transitions in Sweden (HEARTS) study (n = 5718, age 60-66 at baseline). We used a latent curve model with structured residuals, which distinguishes within- and between-person associations and includes cross-lagged parameters.

RESULTS

Higher levels of autonomy at baseline were associated with lower levels of loneliness, and increases in autonomy were associated with decreases in loneliness. When individuals felt more autonomous than usual, they also reported less loneliness. However, the cross-lagged paths were not significant, which means that autonomy did not predict loneliness over time on the within-person level, and loneliness did not predict autonomy over time.

CONCLUSION

Our findings show that higher autonomy was related to lower loneliness on different analytical levels, but the direction of effects is unclear. More research is needed to understand the development of this association over the life span.

Are Perfectionists Always Dissatisfied with Life? An Empirical Study from the Perspective of Self-Determination Theory and Perceived Control

Compared to non-perfectionists, perfectionists may not be satisfied with the growing needs in their lives to the same extent. To test whether perfectionists are dissatisfied with their lives, we investigated whether trait perfectionism attenuates the relationship between basic psychological needs, perceived control, and life satisfaction. A total of 574 college students self-reported basic psychological needs, perceived control, life satisfaction, and perfectionistic strivings and concerns, with a mean age of 19.53 (SD = 1.61), including 299 women and 275 men. A correlation analysis showed that perfectionistic strivings were significantly positively related to life satisfaction, while perfectionistic concerns were significantly negatively related to life satisfaction. The moderation analysis showed that perfectionistic strivings not only moderated the relationship between basic psychological needs and life satisfaction but also moderated the relationship between perceived control and life satisfaction. Individuals with high perfectionistic strivings generally reported high levels of life satisfaction. Perfectionistic strivings, however, reduced the positive relationship between perceived control and life satisfaction. Perfectionistic concerns moderated the relationship between perceived control and life satisfaction-the higher the perfectionistic concerns, the weaker the positive relationship between perceived control and life satisfaction. The study found that individuals with high perfectionistic tendencies are not always dissatisfied with life, but that perfectionism weakens the relationship between basic psychological needs, perceived control, and life satisfaction. We argue that one way to improve happiness is by coaching individuals who are highly perfectionistic to become self-aware of their personality so both their perfectionistic strivings and concerns are more coherent with their values and goals or character.

Nursing Staff Perceptions of Outcomes Related to Honoring Residents' "Risky" Preferences

Nursing homes (NHs) are challenged to consistently deliver person-centered care (PCC), or care based on residents' values and preferences. NH staff associate certain resident preferences with risk. However, there are limited evidence-based person-centered risk management strategies to assist NH staff with risky resident preferences. The purpose of the current study was to explore NH staff perceptions of health and safety outcomes associated with honoring NH residents' risky preferences to inform intervention development. This descriptive, qualitative study used sequential focus groups and content analysis, revealing that nursing staff perceive negative and positive outcomes for staff and residents when seeking to honor residents' risky preferences. This finding is supported by three themes: Potential Harms to Staff, Potential Harms to Residents, and Positive Shared Outcomes. These results contribute a set of nurse-driven quality of life and quality of care outcomes for NH staff and residents associated with PCC delivery in NHs. [Research in Gerontological Nursing, 15(6), 271-281.].

Developing a competence framework for gerontological nursing in China: a two-phase research design including a needs analysis and verification study

Background

China faces a serious shortage of competent nurses who can address the healthcare needs of older people in an ageing society. Chinese higher education institutes face serious challenges when it comes to developing new curricula that are capable of educating sufficient numbers of competent gerontological nurses. Therefore, the aim of this research study was to identify and verify competencies for gerontological nurses in China that are needed to provide nursing care for the growing number of older people in all care settings. This study takes into account the possible opportunities that trends and developments may offer in the near future.

Methods

In this study, a two-phase research design was used. The first phase concerned needs analysis, including a situational analysis, a trend analysis and a competence analysis. This process resulted in a draft competence framework. The second phase addressed the verification of the competence framework through a two-round Delphi study with a panel of Chinese and European experts. This process led to the final competence framework.

Results

The final competence framework for gerontological nursing in China included six competencies divided into 13 essential and five relevant learning outcomes. The competencies are: ‘providing gerontological care’, ‘communication and collaboration’, ‘organization of gerontological nursing care’, ‘health promotion’, ‘evidence-based nursing and lifelong learning’ and ‘professional behaviour’.

Conclusion

The framework comprehensively covers the six core competencies that nurses who care for older people should possess. These competencies are well-embedded in a Chinese context. The framework therefore offers concrete, practical suggestions for the competencies and skills that nursing graduates will need to work in current and future professions related to gerontological nursing education and practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01074-y.

Activity, Activity Personalization, and Well-Being in Nursing Home Residents With and Without Cognitive Impairment: An Integrative Review

OBJECTIVES

Engagement in personally relevant and pleasant activity is a facet of many theories of well-being. This integrated review and narrative synthesis explored the hypothesis that activity participation improves well-being for nursing home residents.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, PsycINFO, Academic Search Complete, Psychology and Behavioral Sciences Collection, Embase, and CINAHL for research published between 2006 and 2018. We included peer-reviewed, English-language studies of nursing-home residents, with interventions focused on activities and on well-being or affect outcomes.

RESULTS

After screening, the search yielded 45 studies: 15 reviews of specific activities and 30 empirical articles. We found consistent support for tailored activity interventions and less consistent support for specific or generic activity interventions with the possible exception of music therapy. Research focused on specific activity types had methodological limitations and confounds with activity preferences.

CONCLUSIONS

Participation in activities may improve well-being in residents of nursing homes. Tailored activities are likely to be superior to those provided indiscriminately to all residents.

CLINICAL IMPLICATIONS

Improving quality of life in long-term care should include opportunities to engage in activities; those most effective will be tailored to individuals and no single activity will be effective for everyone.

Maximizing Well-Being in the Context of Long-Term Services and Supports: A Q Methodological Approach

OBJECTIVES

The goal of this study was to investigate diversity in stakeholders' perspectives on how best to maximize older adults' well-being when they use long-term services and supports (LTSS).

METHODS

We used Q methodology, an exploratory method, to investigate preference patterns among a purposive sample of older adults, family members, and leadership professionals (n = 57). Participants categorized 52 items related to 9 domains of LTSS quality relevant to well-being into categories of importance. We used factors analysis and qualitative methods to identify groups of individuals who identified similar priorities.

RESULTS

The analysis identified four shared viewpoints, each prioritizing different aspects of well-being: 1) physical health and safety; 2) independence; 3) emotional well-being; and 4) social engagement. Individual and contextual factors, including stakeholder role, care needs, and expectations for LTSS, appeared to influence participants' perspectives.

CONCLUSIONS

Distinct viewpoints on how to maximize well-being when older adults use LTSS exist. Our results affirm the importance of person-centered care yet demonstrate that shared preference patterns LTSS exist.

CLINICAL IMPLICATIONS

Engaging with older adults' values and preferences is critical to improving their experiences with LTSS. Better understanding common preference patterns could help providers deliver person-centered care more efficiently and effectively.

Methods to elicit and evaluate the attainment of patient goals in older adults: A scoping review

OBJECTIVE

This scoping review aimed to identify patient goal elicitation and evaluation methods for older adults, and to investigate which methods can be used in medication optimization interventions for nursing home residents (NHRs).

METHODS

The Arksey and O'Malley framework guided the review. A search was launched in PubMed, Embase, CINAHL, and Web of Science. Reference selection and data extraction were performed by three independent reviewers, followed by team discussions to solve discrepancies. Inductive thematic analysis was applied to synthesize the data. Included papers were reconsidered to identify methods for medication optimization interventions for NHRs.

RESULTS

Ninety-six references, encompassing 38 elicitation and 12 evaluation methods, were included. Elicitation methods differed in structure, content, and patient involvement levels. Qualitative and quantitative methods were found to assess goal attainment. Five elicitation and three evaluation methods were developed for NHRs, but none of these contained a medication-related assessment.

CONCLUSION

A variety of goal elicitation and evaluation methods for older adults was found, but none for medication optimization interventions in NHRs.

PRACTICE IMPLICATIONS

A holistic approach seems important to integrate patient goals into medication optimization interventions, not limiting goal elicitation to a medication-related assessment. Also, the choice of assessor seems important to obtain patient goals.

The impact of interaction with children on internet addiction in older adults: A moderated mediation model

Internet addiction among older adults is a new problem in many countries. However, previous studies on excessive Internet use have focused more on young people, and only few studies have focused on Internet addiction in older adults. There is a need to continue to expand research on Internet addiction in older adults. This paper aimed to fill the gap in exiting literature. We adopted a self-reported questionnaire to assess the elderly’s interaction with children, loneliness, life satisfaction and Internet addiction among old adults. A total of 241 old people were obtained from data collection in China via online survey with the help of a professional research company. We used OLS regression analysis and bootstrap method to test the hypothesis. The results of the empirical analysis indicated that (1) interaction with children was significantly negatively associated with the Internet addiction of old people; (2) loneliness mediated the relationship between interaction with children and old adults’ Internet addiction; and (3) life satisfaction moderated the effect of interaction with children, and the indirect effect between interaction with children and old adults’ addiction via loneliness was stronger for those with low life satisfaction. Finally, we discussed the theoretical significance, practical implications, limitation of this research. Interventions to improve family function systems especially for older people with low life satisfaction can help prevent the development of Internet addiction.

Volunteering and loneliness in older adults: A parallel mediation model

OBJECTIVES

This study aimed to examine the relationship between participation in volunteer work and loneliness among older adults, and to explore the mediating role of perceived control and perceived social self-efficacy in this association.

METHOD

This study was developed as a secondary data analysis using the data sampled from the 2016 Health and Retirement Study in USA. The sample comprised 9,944 individuals aged between 65 and 107 years (mean = 75.94, SD = 7.70; 59.4% females). Using a multi-item survey questionnaire, frequent participation in volunteer youth work and charity work, loneliness, perceived control, and social self-efficacy were assessed. To examine the mediating effects of perceived control and social self-efficacy on the association between volunteer work and loneliness, the bootstrapping technique was performed.

RESULTS

Two forms of volunteer works, namely, volunteer youth work and charity work, significantly predicted perceived control, social self-efficacy, and lower levels of loneliness. Perceived control and social self-efficacy appeared to significantly mediate the relationship between volunteer activities and loneliness.

CONCLUSION

The study's findings put forward a need to develop policy provisions that facilitate supporting systems and organizations for life-long education and recruitment of older volunteers. Community-based organizations should create and promote volunteer opportunities in older adults, thereby alleviating later-life loneliness.

The lasting impact of war experiences on quality of life in long-lived retirement homes residents: The birth cohort 1906–1928

Only a few studies have been conducted so far on the long-term impact of war. We investigated whether a life-long impact of the war experiences could be detected in advanced-agers who have successfully overcome all life's challenges. The participants in this study were oldest-old (80+ years) residents of retirement homes in Zagreb (Croatia), who were divided into two groups – ‘war-exposed’ and ‘not-exposed’ – according to their direct war experience (First World War, Second World War, Croatian Homeland War). Within this 1906–1928 birth cohort, a higher percentage of participants with war experiences reached extreme longevity (95+ years). We found no significant difference (p < 0.01) between the two groups concerning demographic and socio-economic characteristics, their life satisfaction, their self-rated current health and functional ability status. Despite numerous similarities, several traits related to life-history, current quality of life, attitudes and reflections distinguish the group of participants with direct war experience. The kind of war involvement – active military service, imprisonment in concentration camps or prisons, forced migration due to war and war-related death of close family members – stretched through various aspects of the life-history features, quality of life and attitudes. It differed for men and women, so it is no wonder that the significance pattern in the two genders mostly seems mutually exclusive. Socio-economic situations strongly differed by gender and according to the kind of war exposure, amplifying the differences within the ‘war-exposed’ group in terms of the life-long impact of wars on their lives. Therefore, we could claim that the war experiences were not the same for everybody, and that they had lasting consequences on the lifecourse of persons who directly faced war-related events. The results also point to the high resilience capacity as a common feature among persons who survived direct exposure to at least two wars and yet survived to exceptionally old age.

The relationship among aging in place, loneliness, and life satisfaction in the elderly in Turkey

PURPOSE

This study was conducted to determine the relationship between aging in place, loneliness, and life satisfaction in older people.

DESIGN AND METHODS

The descriptive and cross-sectional study has used the Aging in Place Scale (APS), the Life Satisfaction Scale (LSS), and the Loneliness Scale for the Elderly (LSFE). The study was examined the correlation among APS, LSS, and LSFE.

FINDING

In our study, when we examined the subscales of the APS scale, we found that the perceived social support, physical competence, and achievable social support of the elderly were at a high level. These high levels led to increased life satisfaction and decreased loneliness.

PRACTICE IMPLICATIONS

The results obtained in this study are particularly important for highlighting the importance of aging in place in reducing loneliness, which has a negative impact on the mental health of the elderly, and in shedding light on increasing life satisfaction in the later stages of life.

The Roles of Life Satisfaction and Community Recreational Facilities in the Relationship between Loneliness and Depression in Older Adults

OBJECTIVES

This study examined the mediating effect of life satisfaction and the moderating effect of the availability of community recreational facilities (CRF) in the association between loneliness and depression in rural older adults and urban older adults, respectively.

METHODS

Quantitative data collected from 7547 Chinese older adults were analyzed using the SPSS macro PROCESS to test a moderated mediation model with life satisfaction as the mediator and CRF availability and residency type (rural vs. urban) as moderators.

RESULTS

Loneliness negatively predicted life satisfaction, life satisfaction negatively predicted depression, and loneliness positively predicted depression. The interaction of loneliness and CRF availability had a significant effect on depression for urban older adults but not for rural older adults. The direct impact of loneliness on depression differed significantly between rural and urban older adults.

CONCLUSIONS

Life satisfaction mediated the association between loneliness and depression in both rural and urban older adults; CRF availability unexpectedly boosted the effect of loneliness on depression in urban older adults but not in rural older adults. Given the same level of loneliness, urban older adults were more likely to be depressed than rural older adults.

CLINICAL IMPLICATIONS

Psychogeriatric practitioners may embed life satisfaction into intervention programs to minimize depression among older adults. Public administrators should examine the utilization of public facilities to avoid wasted resources and counterproductive effects on older adults. Lonely urban older adults deserve special attention.

Managing Perceived Loneliness and Social-Isolation Levels for Older Adults: A Survey with Focus on Wearables-Based Solutions

As an inevitable process, the number of older adults is increasing in many countries worldwide. Two of the main problems that society is being confronted with more and more, in this respect, are the inter-related aspects of feelings of loneliness and social isolation among older adults. In particular, the ongoing COVID-19 crisis and its associated restrictions have exacerbated the loneliness and social-isolation problems. This paper is first and foremost a comprehensive survey of loneliness monitoring and management solutions, from the multidisciplinary perspective of technology, gerontology, socio-psychology, and urban built environment. In addition, our paper also investigates machine learning-based technological solutions with wearable-sensor data, suitable to measure, monitor, manage, and/or diminish the levels of loneliness and social isolation, when one also considers the constraints and characteristics coming from social science, gerontology, and architecture/urban built environments points of view. Compared to the existing state of the art, our work is unique from the cross-disciplinary point of view, because our authors' team combines the expertise from four distinct domains, i.e., gerontology, social psychology, architecture, and wireless technology in addressing the two inter-related problems of loneliness and social isolation in older adults. This work combines a cross-disciplinary survey of the literature in the four aforementioned domains with a proposed wearable-based technological solution, introduced first as a generic framework and, then, exemplified through a simple proof of concept with dummy data. As the main findings, we provide a comprehensive view on challenges and solutions in utilizing various technologies, particularly those carried by users, also known as wearables, to measure, manage, and/or diminish the social isolation and the perceived loneliness among older adults. In addition, we also summarize the identified solutions which can be used for measuring and monitoring various loneliness- and social isolation-related metrics, and we present and validate, through a simple proof-of-concept mechanism, an approach based on machine learning for predicting and estimating loneliness levels. Open research issues in this field are also discussed.

Validade e confiabilidade da Escala de Solidão da UCLA versão 3 entre idosos brasileiros

RESUMO Objetivo avaliar a validade e a confiabilidade da Escala de Solidão da UCLA versão 3 numa amostra de idosos brasileiros. Métodos estudo metodológico, realizado com 136 idosos cadastrados em unidades de saúde da família. A validade de construto foi verificada pela análise fatorial exploratória e correlação com medidas de depressão e apoio social. A confiabilidade foi avaliada pelo alfa de Cronbach. Resultados na análise fatorial exploratória foi extraído um componente cuja variância explicou 43,6% da composição do instrumento. Todos os itens apresentaram cargas fatoriais satisfatórias (≥0,30) distribuídas entre 0,43 e 0,76. A validade de construto também foi apoiada pela correlação positiva entre solidão e depressão (r= 0,665; p≤ 0,001) e correlação negativa entre solidão e apoio social (r= -0,576; p≤0,001). O alfa de Cronbach para a amostra foi de 0,88. Conclusão e implicações para a prática a Escala de Solidão da UCLA versão 3 apresenta evidências de validade e confiabilidade satisfatórias, podendo ser utilizada para avaliação da solidão entre idosos brasileiros.

Implications of COVID-19 on the Loneliness of Older Adults in Residential Care Homes

With little understandings on the loneliness of older adults in residential care homes structured by social contact restrictions, the provision of person-centered care was jeopardized during the pandemic. This study employed hermeneutic phenomenology to explore the lived experiences of loneliness of this population during a 5-month period of the COVID-19 pandemic. We conducted unstructured face-to-face interviews with 15 older adults living in seven residential care homes. Thematic analysis was guided by Van Manen's approach. The essence of loneliness was uncovered as "A deprived sense of self-significance in a familiar world contributes to older adult's disconnection with prior commitments." A sub-theme "From collapse to dissolution of self-understanding" revealed how COVID-19 structured their loneliness. Another sub-theme, "Restoring meanings by establishing connections with entities" illustrated the ways to mitigate loneliness during the pandemic. Activities fostering alternative self-interpretation are important to protect older adults against loneliness.

Cross-Sectional and Longitudinal Association between Neighborhood Environment and Perceived Control in Older Adults: Findings from HRS

The current study examined how neighborhood environments are related to older adults’ perceived control over time. A longitudinal study design was employed using data sampled from the Health and Retirement Study (HRS) 2014 and 2018. In total, 3170 older adults, whose age ranged between 60 and 99 years at the baseline, were followed up with a 4-year lag. Measures included two domains of neighborhood characteristics: social cohesion and physical disorder (at baseline and follow-up) and perceived control (at follow-up). Path coefficients between the latent factors were examined using structural equation modeling. Results showed that there was a significant cross-sectional and longitudinal association between neighborhood social cohesion and older adults’ perceived control, while neighborhood physical disorder was cross-sectionally associated with perceived control. Study findings provide evidence for promoting social integration and social capital in their neighborhood that might contribute to older adults’ perceived competence and beliefs in control.

Relationships of leisure social support and flow with loneliness among nursing home residents during the COVID-19 pandemic: An age-based moderating model

Identifying predictors of loneliness is important to develop interventions that help older adults residing in nursing homes reduce their loneliness, particularly during the COVID-19 pandemic. Therefore, we examined whether leisure social support and flow (also identified as optimal experience) were predictive of loneliness, and whether age moderated the relationship between flow and loneliness. In total, 235 nursing home residents, aged 65 years or older, participated in our study. We conducted in-person surveys to measure their age, leisure social support, flow, and loneliness as well as used multiple linear regression analysis to analyze data. Results indicated that high levels of leisure social support and flow predicted low levels of loneliness. However, age decreased the negative relationship between flow and loneliness. We discuss implications of these results in terms of reducing loneliness, without depending highly on the presence of others, during times of social isolation associated with responses to the COVID-19 pandemic.

Interventions against Social Isolation of Older Adults: A Systematic Review of Existing Literature and Interventions

Social isolation is widespread among older adults, especially those confined to living in nursing homes and long-term care facilities. We completed a systematic review evaluating the effectiveness of 20 interventions used to combat social isolation in older adults. A scoring mechanism based on the Joanna Briggs Appraisal Checklist was utilized to determine the quality of the studies. Searches were conducted in "MedLine", "PubMed", "PsycINFO" and "Aging and Mental Health". Studies completed on group and person-centered interventions against social isolation were the highest quality as the social isolation experienced by older adults decreased after the intervention, and this effect continued in follow-up studies. Other interventions such as volunteering-based interventions also alleviated isolation; however, follow-up studies were not completed to determine long-term efficacy. Given the increase in social isolation faced by older persons during the pandemic, our review can be utilized to create effective interventions to reduce social isolation.

What defines quality of care for older people in aged care? A comprehensive literature review

The quality of the care provided to frail older people in aged care is a concern for all Australians and for the citizens of many other countries internationally. This paper summarizes the methods and findings from an Australian study commissioned by the Royal Commission into Aged Care Quality and Safety to identify and synthesize international literature relating to the quality of care in aged care. A comprehensive literature review was undertaken to search and identify the literature (grey and peer reviewed) relating to quality of care and/or person-centered care in aged care. The review identified nine key themes as salient to the quality of care experience, which include treating the older person with respect and dignity; acknowledging and supporting their spiritual, cultural, religious and sexual identity; the skills and training of the aged care staff providing care; relationships between the older person and the aged care staff; social relationships and the community; supporting the older person to make informed choices; supporting the older person's health and well-being; ensuring the delivery of safe care in a comfortable service environment; and the ability to make complaints and provide feedback to the aged care organization. In practice, particularly in the context of residential care, quality of care has traditionally been measured using clinical indicators of care quality. These findings highlight the central importance of person-centered care and care experience as fundamental tenets of the quality of aged care service delivery in Australia and internationally. Geriatr Gerontol Int 2021; 21: 765-778.

Loneliness, Sense of Control, and Risk of Dementia in Healthy Older Adults: A Moderated Mediation Analysis

Objectives: Despite the rising prevalence of dementia, little research has been conducted to identify modifiable psychological factors that alleviate the risk of dementia in older adults and the underlying mechanisms. Given that loneliness is, in part, concomitant with a weakened sense of control, we examined whether sense of control would mediate the relation between loneliness and dementia risk. Further, considering that working -memory capacity is a critical cognitive resource that serves as a buffer against age-related cognitive decline, we examined a second-order moderated mediational model whereby working-memory capacity moderates the relation between control beliefs and dementia risk in older adults.

METHODS

We administered a series of measures to older community-dwelling adults (ages 60-93; N = 69), including the participant-rated AD8 to assess the risk of dementia. Using the PROCESS macro, we examined the moderated mediation model for the relation between loneliness, sense of control, and dementia risk.

RESULTS

We found that sense of control significantly mediated the relation between loneliness and risk of dementia. Moreover, the indirect effect of loneliness on dementia risk via lowered sense of control was significant only in individuals with poorer working-memory capacity. Notably, these findings held true when important covariates were controlled for.

CONCLUSIONS

Our findings underscore the critical role of control beliefs and working memory in protecting against dementia risk.

CLINICAL IMPLICATIONS

Our findings have implications for intervention programs that target alleviating dementia risk and promoting healthy aging in older adults by improving socioemotional health and cognitive functioning.

Access to Epidemic Information and Life Satisfaction under the Period of COVID-19: the Mediating Role of Perceived Stress and the Moderating Role of Friendship Quality

The present study mainly focused on college students amidst the COVID-19 outbreak and aimed to develop and examine a moderated mediation model between access to epidemic information and life satisfaction. Friendship quality as a moderator, and perceived stress as a mediator. A sample of 1032 college students participated in this study and completed questionnaires regarding access to epidemic information, perceived stress, friendship quality, and life satisfaction. Findings indicated that 1) access to epidemic information was strongly related to life satisfaction; 2) perceived stress acts as a mediator in the positive relationship between access to epidemic information and life satisfaction; 3) friendship quality moderated the relationship between access to epidemic information and perceived stress as well as perceived stress and life satisfaction, and such that there was a stronger association between access to epidemic information and perceived stress for college students with high friendship quality. But the relationship between perceived stress and life satisfaction became weaker for college students with high friendship quality. The results illuminate the mechanism to theoretical and practical implications for improving college students' life satisfaction during the pandemic.

Effects of Laughter Therapy on Life Satisfaction and Loneliness in Older Adults Living in Nursing Homes in Turkey: A Parallel Group Randomized Controlled Trial

PURPOSE

This study examined the effects of laughter therapy on life satisfaction and loneliness in older adults living in nursing homes.

DESIGN

A single-blind, parallel-group, randomized controlled trial (ClinicalTrials NCT03687788) with a pretest-posttest design was conducted.

METHODS

There were 31 experimental participants and 31 controls. The experimental group received laughter therapy twice a week for 6 weeks, along with usual care. The control group received usual care only. Loneliness was measured with the De Jong Gierveld Loneliness Scale, and life satisfaction was measured with the Satisfaction With Life Scale.

FINDINGS

After 6 weeks, there was a statistically significant difference in De Jong Gierveld Loneliness Scale total score between the two groups, and the subscale scores of the experimental group decreased.

CONCLUSIONS

Laughter therapy may reduce loneliness in older adults.

CLINICAL RELEVANCE

Healthcare professionals, especially nurses, can potentially use laughter therapy to reduce loneliness in older adults.

Iatrogenic loneliness and loss of intimacy in residential care

BACKGROUND

There is an international trend for frail older adults to move to residential care homes, rather than ageing at home. Residential facilities typically espouse a person-centred philosophy, yet evidence points to restrictive policies and surveillance resulting in increased loneliness and diminished opportunities for intimacy and sexual expression. Residents may experience what has been termed social death, rather than perceive they are related to by others as socially alive.

AIM

To consider how the loss of intimacy and sexuality in residents' lives contributes to iatrogenic loneliness experienced in residential care, and the importance of considering these issues together.

RESEARCH DESIGN

The study utilised a constructionist methodology, investigating the meanings associated with intimacy, loneliness, and ageing.

PARTICIPANTS AND RESEARCH CONTEXT

Qualitative data used in this study are drawn from a larger dataset of a mixed-methods study. Interviews were completed as follows: staff, 21 individual interviews, and two groups with a total of 13 additional people; residents, 26 interviews with 28 people; and family members, 12 interviews with 13 people.

FINDINGS

Five key themes were identified in the data analysis: loneliness and relational identity, loneliness and functional relationships, loneliness and disrupted intimacy, loneliness and liminality, and loneliness and the built environment.

ETHICAL CONSIDERATIONS

The study was approved by a University Human Ethics Committee. Participation was voluntary. Consent was gained and confidentiality upheld.

DISCUSSION

Residents' expression of intimacy and sexuality can be compromised through paternalism, ageism, restrictive policies, care-rationing and functional care, alienating residents from sustaining and developing significant relationships. Attitudes and cultural beliefs of staff and family members about ageing and intimacy, compounded by architectural design, may intensify loneliness.

CONCLUSIONS

Nurses have a pivotal role in ensuring policies and practice enhance social citizenship.

Pervasive Risk Avoidance: Nursing Staff Perceptions of Risk in Person-Centered Care Delivery

BACKGROUND AND OBJECTIVES

Nursing home (NH) staff perceptions of risks to residents' health and safety are a major barrier to honoring resident preferences, the cornerstone of person-centered care (PCC) delivery. This study explored direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents' preferences for everyday living and care activities.

RESEARCH DESIGN AND METHODS

Qualitative, descriptive design using sequential focus group (FG) methodology.

RESULTS

Participants (N = 27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs recently experiencing 6-12 health citations. Content analysis of 12 sequential FGs indicated nursing staff perceptions of risks may impede delivery of person-centered care. This is supported by the overarching theme: pervasive risk avoidance; and subthemes of: staff values, supports for risk-taking, and challenges to honoring preferences.

DISCUSSION AND IMPLICATIONS

Development of a multidimensional framework with specific risk engagement measures that account for the unique risk perspectives of nursing staff will contribute significantly to the clinical management of older adult preferences and research on the effectiveness of preference-based PCC delivery in the NH setting.

Unmet and Unimportant Preferences Among Nursing Home Residents: What Are Key Resident and Facility Factors?

OBJECTIVES

The Preferences Assessment Tool (PAT) in the Minimum Data Set (MDS) 3.0 assesses 16 resident preferences for daily routines and activities. Although integrating important preferences into care planning is essential to provide person-centered care in nursing homes (NHs), preferences rated as important but unmet or unimportant may not receive much attention. This study aims to (1) identify the prevalence of unmet preferences and unimportant preferences, and (2) examine their associations with resident and facility-level characteristics.

DESIGN

This is a longitudinal study of residents in NHs.

SETTINGS AND PARTICIPANTS

We used data from 2012-2017 MDS assessments of long-stay residents aged 65 or older in 295 Minnesota NHs. In total, 51,859 assessments from 25,668 residents were included.

METHODS

Generalized linear mixed models were used to analyze resident and facility-level characteristics associated with having any unmet preferences, and with the number of unimportant preferences.

RESULTS

Across all years for both daily routine preferences and activity preferences, 3.3% to 5.1% of residents reported that at least 1 or more preference was important but unmet, and 10.0% to 16.6% reported that 4 or more out of the 8 preferences were unimportant. Residents with higher depressive symptoms, and poorer physical and sensory function were more likely to report unmet preferences. Residents with poorer physical and sensory function, and living in rural facilities and facilities having fewer activity staff hours per resident day were more likely to report unimportant preferences.

CONCLUSIONS AND IMPLICATIONS

Residents with functional and sensory limitations and living in underresourced NHs are more likely to report that preferences are unimportant, or that they are important but unmet. It is important for staff to elicit preferences that truly matter for residents, and to enable residents to meet their preferences.

A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings

THE PURPOSE

of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+).

METHOD

A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish.

RESULTS

In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation.

CONCLUSION

Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.

The Effects of Nursing Home Culture Change on Resident Quality of Life in U.S. Nursing Homes: An Integrative Review

Culture change is intended to transform nursing homes from impersonal institutions into person-centered homes. Despite a growing interest in studying culture change, empirical evidence for its effects on quality of life (QOL) has not been synthesized. The current integrative review examined how QOL outcomes were measured in culture change studies and analyzed the current evidence for culture change effects on QOL. Guided by a conceptual framework, this review systematically searched for literature in multiple databases and identified 11 eligible studies. QOL measures varied across studies, ranging from overall perception of life to specific measures associated with physical and psychosocial well-being. Overall, culture change demonstrated a positive trend in benefiting QOL. Although inconsistent evidence existed for most QOL measures, relatively consistent evidence was found to support positive effects on resident satisfaction and autonomy. Rigorous designs are needed for future studies to generate strong evidence. [Research in Gerontological Nursing, xx(x), xx-xx.].