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Davis L, Botting N, Cruice M, Dipper L. Communication support in care homes for older adults: Views and reported practices of speech and language therapists and care home activities staff in the UK. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:1404-1421. [PMID: 38230914 DOI: 10.1111/1460-6984.13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. AIMS To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. METHODS AND PROCEDURES Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID-19. Results were analysed using descriptive statistics and qualitative content analysis. OUTCOMES AND RESULTS A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%-87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%-89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. CONCLUSIONS AND IMPLICATIONS SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. WHAT THIS PAPER ADDS What is already known on the subject There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles.
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Affiliation(s)
- Lydia Davis
- Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Nicola Botting
- Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Madeline Cruice
- Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Lucy Dipper
- Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, UK
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Berkovic D, Macrae A, Gulline H, Horsman P, Soh SE, Skouteris H, Ayton D. The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2024; 64:gnad052. [PMID: 37144737 PMCID: PMC11020247 DOI: 10.1093/geront/gnad052] [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] [Received: 08/10/2022] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Person-centered care is the gold standard of care for people living with dementia, yet few systematic reviews have detailed how it is delivered in practice. This mixed-methods review aimed to examine the delivery of person-centered care, and its effectiveness, for people living with dementia in residential aged care. RESEARCH DESIGN AND METHODS A systematic review and meta-analysis. Eligible studies were identified across 4 databases. Quantitative and qualitative studies containing data on person-centered care delivered to people with dementia living in residential aged care were included. Meta-analysis using a random-effects model was conducted where more than 3 studies measured the same outcome. A narrative meta-synthesis approach was undertaken to categorize verbatim participant quotes into representative themes. Risk of bias was undertaken using quality appraisal tools from the Joanna Briggs Institute. RESULTS 41 studies were identified for inclusion. There were 34 person-centered care initiatives delivered, targeting 14 person-centered care outcomes. 3 outcomes could be pooled. Meta-analyses demonstrated no reduction in agitation (standardized mean difference -0.27, 95% confidence interval [CI], -0.58, 0.03), improvement in quality of life (standardized mean difference -0.63, 95% CI: -1.95, 0.70), or reduced neuropsychiatric symptoms (mean difference -1.06, 95% CI: -2.16, 0.05). Narrative meta-synthesis revealed barriers (e.g., time constraints) and enablers (e.g., staff collaboration) to providing person-centered care from a staff perspective. DISCUSSION AND IMPLICATIONS The effectiveness of person-centered care initiatives delivered to people with dementia in residential aged care is conflicting. Further high-quality research over an extended time is required to identify how person-centered care can be best implemented to improve resident outcomes.
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Affiliation(s)
- Danielle Berkovic
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ann Macrae
- Mission & Corporate Development, Baptcare, Melbourne, Victoria, Australia
| | - Hannah Gulline
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Phillipa Horsman
- Service Strategy Manager, Baptcare, Melbourne, Victoria, Australia
| | - Sze-Ee Soh
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Warwick Professor in Health and Social Care Improvement and Implementation Science, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Mauldin RL, Westmore MR, Tulloh A, Anderson KA. Well-Being Outcomes from the Delivery of RASCALs, a Group Activity Intervention Using Nature-Focused Livestream Broadcasts. Gerontol Geriatr Med 2024; 10:23337214241273230. [PMID: 39184398 PMCID: PMC11342327 DOI: 10.1177/23337214241273230] [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: 05/08/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 08/27/2024] Open
Abstract
Group activities and connection with nature are associated with improved well-being for older adults. This quasi-experiment tests the effectiveness of RASCALs, an innovative program of group activities using nature-focused livestream broadcasts. Assisted living residents in the experimental group (n = 16) lived in buildings that received RASCALs programming twice a week for 3 months. Compared to residents in the comparison group (n = 17) who received regular group activity programming, they experienced significant positive change in the Positive Relations with Others domain of well-being (β = .873, p = .008). Combining nature-focused livestream broadcasts with groups activities for older adults in assisted living communities may be an innovative and effective way to overcome barriers to accessing nature and improve residents' well-being.
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Affiliation(s)
| | | | - Anna Tulloh
- The University of Texas at Arlington, Arlington, TX, USA
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Robinson K, Fitzgerald C, Galvin R, O' Connor A. Exploring the facilitation of meaningful leisure activities in designated centres for older persons (nursing homes) in Ireland: A protocol for content documentary analysis of HIQA inspection reports. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13639.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Nursing homes (NHs) in Ireland are regulated by the Health Information and Quality Authority (HIQA). Regulations for nursing homes under the Health Act 2007 (as amended) states that registered providers must provide residents with facilities for occupation and recreation, and opportunities to participate in activities in accordance with their interests and capacities (Government of Ireland, 2013 - S.I. No. 415/2013). Despite the proven benefits of engagement in meaningful activities, when an older person enters a NH, they often lose autonomy in occupational roles, and engagement in meaningful activities (Causey-Upton, 2015). In 2019, HIQA highlighted that there were relatively high levels of non-compliance in the area of residents’ rights (HIQA, 2020). Aim: Given the central role of leisure activities to older adults’ health and well-being, this study aims to understand how NH residents in Ireland were afforded opportunities for meaningful engagement in activities prior to and throughout the COVID-19 pandemic (2019 – 2021). This will be conducted through analysing a sample of publicly available HIQA inspection reports for NHs from 2019 – 2021. Methods: A content documentary analysis will be conducted using a qualitative deductive approach. Purposive sampling will be used to select 21 nursing home reports for the years 2019, 2020 and 2021. The sample will include nursing homes reported to be non-compliant, substantially compliant and compliant in the regulation of residents’ rights. An inspection report for each of these NHs (n=21) for the year 2019, 2020 and 2021 will create a sample of 63 reports for analysis. This sample will capture three time points for the 21 NHs pre-pandemic and throughout the pandemic.
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Amir SN, Juliana N, Azmani S, Abu IF, Talib AHQA, Abdullah F, Salehuddin IZ, Teng NIMF, Amin NA, Azmi NASM, Aziz NASA. Impact of Religious Activities on Quality of Life and Cognitive Function Among Elderly. JOURNAL OF RELIGION AND HEALTH 2022; 61:1564-1584. [PMID: 34536189 PMCID: PMC8449521 DOI: 10.1007/s10943-021-01408-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 06/03/2023]
Abstract
Religiosity and spirituality have previously been found to have significant effects on mental and physical health. This study aimed to compare elderly people utilizing different types of religious activities in their daily routine and the effects upon their quality of life and cognitive function. A cross-sectional study was conducted among elderly people dwelling in suburban areas of Malaysia. The Malay version of Short Form (36) Health Survey (SF-36), Geriatric Depression Scale (GDS-15), Older Americans Resources and Services's Instrumental Activities of Daily Living (OARS's IADL), and the Montreal Cognitive Assessment (MoCA) questionnaires were used in this study. Independent t test was utilized to determine the difference in the quality of life and the cognitive function between groups of elderly people that were categorized based on their level of participation in different religious activities. The study involved 432 participants. The mean score for all domain of SF-36 was significantly higher among those who engaged in the religious activities as compared to those elderly who were either less engaged or did not practice religious activities. The mean score of GDS-15, OARS's IADL, and MoCA was also significantly higher among those who participated in religious activities. There was a significant impact on the quality of life and cognitive function among elderly people practicing religious activities. This study proved the importance of practicing religious activities among the elderly in achieving healthy aging.
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Affiliation(s)
- Syazwan Nazri Amir
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan Malaysia
| | - Norsham Juliana
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan Malaysia
| | - Sahar Azmani
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan Malaysia
| | - Izuddin Fahmy Abu
- Institute of Medical Science Technology, Universiti Kuala Lumpur, 43000 Kajang, Malaysia
| | | | - Farahin Abdullah
- Institute of Medical Science Technology, Universiti Kuala Lumpur, 43000 Kajang, Malaysia
| | | | - Nur Islami Mohd Fahmi Teng
- Faculty of Health Sciences, Universiti Teknologi MARA Cawangan Selangor, 42300 Bandar Puncak Alam, Malaysia
| | - Nur Azma Amin
- Institute of Medical Science Technology, Universiti Kuala Lumpur, 43000 Kajang, Malaysia
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The Relationship Between Physical Activity and Health-Related Quality of Life in People With Dementia: An Observational Study. J Aging Phys Act 2021; 30:626-634. [PMID: 34686622 DOI: 10.1123/japa.2021-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
Abstract
Recent research suggests the positive effect of physical activity on health-related quality of life in people with dementia may be mediated through improved activities of daily living and reduced depressive symptoms. One hundred and twenty-four people with dementia and their informal carers were recruited from the South East of England for this observational study. A subset of participants wore an accelerometer for 30 days. A series of bivariate analyses were completed, alongside mediation analyses. In people with mild to moderate severity dementia, weak positive associations were widely reported between physical activity indices and health-related quality of life, though only a single association reached statistical significance (rs = .25, p = .03). Mediation analysis revealed no significant indirect effects across the models after controlling for cognition. Future research needs to explore such relationships with a greater emphasis on the modality and psychosocial components of physical activity rather than just frequency, duration, and intensity.
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Psychometric properties and feasibility of use of dementia specific quality of life instruments for use in care settings: a systematic review. Int Psychogeriatr 2021; 33:917-931. [PMID: 30602403 DOI: 10.1017/s1041610218002259] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Over 400,000 people live in care home settings in the UK. One way of understanding and improving the quality of care provided is by measuring and understanding the quality of life (QoL) of those living in care homes. This review aimed to identify and examine the psychometric properties including feasibility of use of dementia-specific QoL measures developed or validated for use in care settings. DESIGN Systematic review. METHODS Instruments were identified using four electronic databases (PubMed, PsycINFO, Web of Science, and CINAHL) and lateral search techniques. Searches were conducted in January 2017. Studies which reported on the development and/or validation of dementia specific QoL instruments for use in care settings written in English were eligible for inclusion. The methodological quality of the studies was assessed using the COSMIN checklist. Feasibility was assessed using a checklist developed specifically for the review. RESULTS Six hundred and sixteen articles were identified in the initial search. After de-duplication, screening and further lateral searches were performed, 25 studies reporting on 9 dementia-specific QoL instruments for use in care home settings were included in the review. Limited evidence was available on the psychometric properties of many instruments identified. Higher-quality instruments were not easily accessible or had low feasibility of use. CONCLUSIONS Few high-quality instruments of QoL validated for use in care home settings are readily or freely available. This review highlights the need to develop a well-validated measure of QoL for use within care homes that is also feasible and accessible.
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Baldelli G, De Santi M, De Felice F, Brandi G. Physical activity interventions to improve the quality of life of older adults living in residential care facilities: a systematic review. Geriatr Nurs 2021; 42:806-815. [PMID: 34090224 DOI: 10.1016/j.gerinurse.2021.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Pursuing active aging and maintaining the quality of life (QoL) is essential, particularly in older people living in residential care facilities (RCFs). We evaluated physical activity (PA) as an intervention to improve the QoL in this population, trying to hypothesize future perspectives in this field. METHODS A systematic search was performed on Pubmed. Only randomized control trials or quasi-experimental control group trials were considered. RESULTS Results showed that a high-frequency PA can be effective in older people, allowing them to improve their functional mobility, autonomy, anxiety level, balance, and social interactions. Moreover, a moderate-intensity PA showed the most interesting results, improving all the QoL-related aspects considered. CONCLUSION Results highlight the beneficial effects of multidisciplinary intervention strategies in increasing QoL and QoL-related aspects of RCFs older residents, contemplating PA as the main instrument. However, structured PA is necessary to fully understand which protocol could be the most effective.
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Affiliation(s)
- Giulia Baldelli
- Biomolecular Sciences Department, Public Health Unit, University of Urbino Carlo Bo, Urbino, Italy.
| | - Mauro De Santi
- Biomolecular Sciences Department, Public Health Unit, University of Urbino Carlo Bo, Urbino, Italy
| | | | - Giorgio Brandi
- Biomolecular Sciences Department, Public Health Unit, University of Urbino Carlo Bo, Urbino, Italy
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Sandgren A, Arnoldsson L, Lagerholm A, Bökberg C. Quality of life among frail older persons (65+ years) in nursing homes: A cross-sectional study. Nurs Open 2021; 8:1232-1242. [PMID: 34482652 PMCID: PMC8046081 DOI: 10.1002/nop2.739] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/28/2020] [Accepted: 11/11/2020] [Indexed: 11/09/2022] Open
Abstract
AIM To assess the quality of life in frail older persons (65+ years) living in nursing homes and to examine differences between quality of life perceptions among different gender and age groups. DESIGN Cross-sectional. METHODS Data were collected during 2015-2017 based on two questionnaires (WHOQOL-OLD and WHOQOL-BREF). Seventy-eight older persons living in nursing homes in southern Sweden answered the questionnaires in structured interviews. Descriptive and comparative statistics were used to analyse the data. The study was guided by Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines. RESULTS The frail older persons reported low autonomy related to few opportunities to engage in everyday activities and were unable to do the things they liked to do and not feeling in control of their future. Another important result was that frail older persons seemed to have no or little fear of death and dying. No significant differences between gender or age on quality of life were revealed.
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Affiliation(s)
- Anna Sandgren
- Department of Health and Caring SciencesFaculty of Health and Life SciencesCenter for Collaborative Palliative CareLinnaeus UniversityVäxjöSweden
| | - Lisa Arnoldsson
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
| | - Annika Lagerholm
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
| | - Christina Bökberg
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
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Sustainable Care and Factors Associated with Quality of Life among Older Beneficiaries of Social Services. SUSTAINABILITY 2021. [DOI: 10.3390/su13031572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Population aging has led to an increased recognition of the problems encountered by older persons. As a consequence, the most recent years have been marked by a series of changes with regard to the organization and provision of social services for dependent older people. The aim of this article is to identify factors associated with the quality of life in old age, using a logistic regression applied to the data collected following a field survey among the beneficiaries of social services. The analysis revealed that men are more likely to appreciate that life does not make sense, compared to dependent elderly women. Age is also a significant factor that influences the quality of life: the older the people are, the more they tend to think in a positive manner about their life. Health, social participation and food are also important factors that influence the perception regarding the quality of life.
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Farina N, King D, Burgon C, Berwald S, Bustard E, Feeney Y, Habibi R, Comas-Herrera A, Knapp M, Banerjee S. Disease severity accounts for minimal variance of quality of life in people with dementia and their carers: analyses of cross-sectional data from the MODEM study. BMC Geriatr 2020. [PMID: 32631252 DOI: 10.1186/s12877‐020‐01629‐1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the progressive nature of dementia, it is important to understand links between disease severity and health-related outcomes. The aim of this study is to explore the relationship between disease severity and the quality of life (QoL) of people with dementia and their family carers using a number of disease-specific and generic measures. METHODS In the MODEM cohort study, three-hundred and seven people with clinically diagnosed dementia and their carers were recruited on a quota basis to provide equal numbers of people with mild (standardised Mini-Mental State Examination (sMMSE), n = 110), moderate (sMMSE 10-19, n = 100), and severe (sMMSE 0-9, n = 97) cognitive impairment. A series of multiple regression models were created to understand the associations between dementia severity and the QoL of people with dementia and the QoL of their carers. QoL was measured using self- (DEMQOL, EQ-5D, CASP-19) and proxy-reports (DEMQOL-Proxy, EQ-5D) of disease-specific and generic QoL of the person with dementia. Carer generic QoL was measured by self-report (EQ-5D, SF-12). RESULTS Disease severity, as measured by the sMMSE, was not significantly associated with the QoL of the person with dementia or the carer (p > 0.05), even after controlling for potential confounding variables for self-reported instruments. Proxy measures (rated by the carer) differed systematically in that there were small, but statistically significant proportions of the variance of QoL was explained by severity of cognitive impairment in multiple adjusted models. We also found little in the way of statistically significant relationships between the QoL of people with dementia and that of their carers except between DEMQOL-Proxy scores and the carer EQ-5D scores and carer SF-12 mental sub-scores. CONCLUSIONS The data generated supports the somewhat counterintuitive argument that severity of cognitive impairment (and therefore severity of dementia) is not associated with lower QoL for the person with dementia when self-report measures are used. However, in absolute terms, as judged by the variance in the multivariate models, it is clear that the contribution of dementia severity to the QoL of people with dementia is minimal whatever the measurement used, be it self- or proxy-rated, or disease-specific or generic.
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Affiliation(s)
- Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK.
| | - Derek King
- London School of Economics and Political Science, London, UK
| | - Clare Burgon
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK.,Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Sharne Berwald
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Elizabeth Bustard
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Yvonne Feeney
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Ruth Habibi
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | | | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK.,Faculty of Health, University of Plymouth, Plymouth, UK
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Farina N, King D, Burgon C, Berwald S, Bustard E, Feeney Y, Habibi R, Comas-Herrera A, Knapp M, Banerjee S. Disease severity accounts for minimal variance of quality of life in people with dementia and their carers: analyses of cross-sectional data from the MODEM study. BMC Geriatr 2020; 20:232. [PMID: 32631252 PMCID: PMC7339395 DOI: 10.1186/s12877-020-01629-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the progressive nature of dementia, it is important to understand links between disease severity and health-related outcomes. The aim of this study is to explore the relationship between disease severity and the quality of life (QoL) of people with dementia and their family carers using a number of disease-specific and generic measures. METHODS In the MODEM cohort study, three-hundred and seven people with clinically diagnosed dementia and their carers were recruited on a quota basis to provide equal numbers of people with mild (standardised Mini-Mental State Examination (sMMSE), n = 110), moderate (sMMSE 10-19, n = 100), and severe (sMMSE 0-9, n = 97) cognitive impairment. A series of multiple regression models were created to understand the associations between dementia severity and the QoL of people with dementia and the QoL of their carers. QoL was measured using self- (DEMQOL, EQ-5D, CASP-19) and proxy-reports (DEMQOL-Proxy, EQ-5D) of disease-specific and generic QoL of the person with dementia. Carer generic QoL was measured by self-report (EQ-5D, SF-12). RESULTS Disease severity, as measured by the sMMSE, was not significantly associated with the QoL of the person with dementia or the carer (p > 0.05), even after controlling for potential confounding variables for self-reported instruments. Proxy measures (rated by the carer) differed systematically in that there were small, but statistically significant proportions of the variance of QoL was explained by severity of cognitive impairment in multiple adjusted models. We also found little in the way of statistically significant relationships between the QoL of people with dementia and that of their carers except between DEMQOL-Proxy scores and the carer EQ-5D scores and carer SF-12 mental sub-scores. CONCLUSIONS The data generated supports the somewhat counterintuitive argument that severity of cognitive impairment (and therefore severity of dementia) is not associated with lower QoL for the person with dementia when self-report measures are used. However, in absolute terms, as judged by the variance in the multivariate models, it is clear that the contribution of dementia severity to the QoL of people with dementia is minimal whatever the measurement used, be it self- or proxy-rated, or disease-specific or generic.
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Affiliation(s)
- Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK.
| | - Derek King
- London School of Economics and Political Science, London, UK
| | - Clare Burgon
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Sharne Berwald
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Elizabeth Bustard
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Yvonne Feeney
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Ruth Habibi
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | | | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
- Faculty of Health, University of Plymouth, Plymouth, UK
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Li J, Xu X, Sun J, Cai W, Qin T, Wu M, Liu H. Activities of daily living, life orientation, and health-related quality of life among older people in nursing homes: a national cross-sectional study in China. Qual Life Res 2020; 29:2949-2960. [PMID: 32632641 DOI: 10.1007/s11136-020-02571-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to explore the current status of activities of daily living (ADLs), life orientation, and health-related quality of life (HRQoL) among older people in nursing homes and to further examine the mediating role of life orientation in the impact of ADLs on HRQoL. METHODS A national cross-sectional study was conducted among older people aged 60 and above in nursing homes by the randomly stratified cluster sampling method. The status of ADLs, life orientation and HRQoL were measured using an ADL scale, a life orientation scale and the SF-12v2 scale, respectively. Multiple linear regression models were used to identify explanatory factors associated with ADLs, life orientation, and HRQoL. The potential mediating role of life orientation in the relationship between ADL and HRQoL was explored by mediation analysis. RESULTS The overall prevalence of ADL disability was 52.67%, and 84.37% of older people in nursing homes had a negative life orientation. The mean scores of physical health and mental health among older people in nursing homes were 45.44 ± 6.46 and 42.67 ± 8.48, respectively. Some sociodemographic characteristics were associated with poor physical health and mental health. After adjustments were made for covariates, the life orientation score mediated 13.81% of the total effect of the ADL score on physical component score of HRQoL and mediated 45.33% of the mental component score of HRQoL. CONCLUSION A sizeable proportion of older people had ADL disability and negative life orientation, and HRQoL was poor among older Chinese people in nursing homes. Life orientation partially mediates the relationship between ADLs and HRQoL.
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Affiliation(s)
- Junling Li
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Xueying Xu
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Jinbin Sun
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Weijie Cai
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Tiantian Qin
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Mingcheng Wu
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Hongbo Liu
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China.
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Knecht-Sabres LJ, Del Rosario EP, Erb AK, Rozko M, Guzman R. Are the Leisure and Social Needs of Older Adults Residing in Assisted Living Facilities Being Met? PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2019.1702134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Lisa J. Knecht-Sabres
- Department of Occupational Therapy, Midwestern University, Downers Grove, Illinois, USA
| | - Erica P. Del Rosario
- Department of Occupational Therapy, Midwestern University, Downers Grove, Illinois, USA
| | - Amanda K. Erb
- Department of Occupational Therapy, Midwestern University, Downers Grove, Illinois, USA
| | - Malgorzata Rozko
- Department of Occupational Therapy, Midwestern University, Downers Grove, Illinois, USA
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Hughes LJ, Farina N, Page TE, Tabet N, Banerjee S. Adaptation of the DEMQOL-Proxy for routine use in care homes: a cross-sectional study of the reliability and validity of DEMQOL-CH. BMJ Open 2019; 9:e028045. [PMID: 31399452 PMCID: PMC6701562 DOI: 10.1136/bmjopen-2018-028045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the routine use of a measure of quality of life (QoL) in care homes and assess its psychometric properties when used by care staff. DESIGN A cross-sectional two-phase study. SETTING AND PARTICIPANTS Data were collected from care staff in seven care homes in East Sussex, England. METHOD Phase I: The ability of care staff from two care homes to use the DEMQOL-Proxy without interviewer administration was assessed using agreement analysis between a self-administered and interviewer-administered version of the instrument. Based on these findings, DEMQOL-Proxy was adapted into a new version, DEMQOL-CH, for use as a self-administered instrument in care homes. We assessed agreement between the new DEMQOL-CH and DEMQOL-Proxy to ensure DEMQOL-CH was used correctly. Phase II: A preliminary assessment of the psychometric properties of DEMQOL-CH when used routinely was completed in a further five care homes. RESULTS Phase I: Nineteen care staff from two care homes completed QoL measurements for residents. Systematic error was identified when staff self-completed the DEMQOL-Proxy without an interviewer. We modified the DEMOoL-Proxy to create DEMQOL-CH; this reduced the error, producing a version that could be used more accurately by care staff. Phase II: Eleven care staff from five care homes rated resident QoL routinely. DEMQOL-CH showed acceptable psychometric properties with satisfactory reliability and validity and a clear factor structure. CONCLUSIONS The research presents positive preliminary data on the acceptability, feasibility and performance of routine QoL measurement in care homes using an adapted version of DEMQOL-Proxy, the DEMQOL-CH. Results provide evidence to support the concept that routine measurement of QoL may be possible in care homes. Research is needed to refine and test the methodology and instrument further and to explore the potential for benefits to residents, staff and care homes in larger and more representative populations.
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Affiliation(s)
- Laura J Hughes
- Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| | - Nicolas Farina
- Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| | | | - Naji Tabet
- Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| | - Sube Banerjee
- Neuroscience, Brighton and Sussex Medical School, Brighton, UK
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Robleda S, Pachana NA. Quality of Life in Australian Adults Aged 50 Years and Over: Data Using the Schedule for the Evaluation of Individual Quality of Life (SEIQOL-DW). Clin Gerontol 2019; 42:101-113. [PMID: 29220621 DOI: 10.1080/07317115.2017.1397829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study explored unique and personal domains associated with quality of life (QOL) in 153 mid-aged and older Australian adults over age 50, using an innovative measure of individualized QOL, the Schedule for the Evaluation of Individual Quality of Life (SEIQOL-DW). METHODS Demographic measures as well as the SEIQOL-DW were administered. The qualitative responses on this scale were analyzed by Leximancer, a text analysis program that extracts semantic meaning and relational information automatically from text. RESULTS For the sample as a whole, the most important QOL domain was found to be Relationships, followed by Family, Health, Activities, Community, Security, Beliefs, Independence and finally Wellbeing. When the sample was broken down into age bands for analysis, the most important domain theme was Family (50-59 year olds), Relationships (60-69 year olds), Relationships (70-79 year olds), and Health (80+ year olds). CONCLUSIONS The wide range of concepts elicited in each domain via Leximancer underscores the argument for analyzing QOL in an individualized way, as it was clear from these concepts that different domains had unique meanings to each person. CLINICAL IMPLICATIONS Understanding QOL at the level of which domains in an individual are important to QOL in later life is critical to providing services to both healthy aged as well as those with health and mental health needs. The SEIQOL-DW affords clinicians a unique tool with which to describe an individual's unique and relevant quality of life areas, and affords a way to measure change in these areas as a result of interventions.
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Affiliation(s)
- Sofia Robleda
- a School of Psychology , The University of Queensland , Brisbane , Australia
| | - Nancy A Pachana
- a School of Psychology , The University of Queensland , Brisbane , Australia
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Sanvezzo VMDS, Montandon DS, Esteves LSF. Instruments for the functional assessment of elderly persons in palliative care: an integrative review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.180033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: to identify validated instruments that can be used for the functional assessment of elderly persons in Palliative Care. Method: an integrative review focused on identifying instruments for the functional assessment of elderly persons in palliative care was carried out by searching publications in periodicals indexed in seven electronic databases. Descriptors, keywords and Boolean operators were used for a cross-database search in November 2017. A total of 357 abstracts were identified, from which 53 articles were selected for reading, of which 21 met the inclusion criteria. Results: this strategy allowed the identification of eight scales and one test for the functional assessment of elderly persons in palliative care. Conclusion: eight scales and a functional test which also provide guidelines for improving the quality of life of elderly people in palliative care were identified, demonstrating that it is practically impossible to disassociate physical functional performance from social and psychological aspects.
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Cheng CL, Plashkes T, Shen T, Fallah N, Humphreys S, O'Connell C, Linassi AG, Ho C, Short C, Ethans K, Charbonneau R, Paquet J, Noonan VK. Does Specialized Inpatient Rehabilitation Affect Whether or Not People with Traumatic Spinal Cord Injury Return Home? J Neurotrauma 2017; 34:2867-2876. [DOI: 10.1089/neu.2016.4930] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Tova Plashkes
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Tian Shen
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | | | - Colleen O'Connell
- Physical Medicine and Rehabilitation, Dalhousie University, Fredericton, New Brunswick, Canada
| | - A. Gary Linassi
- Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Christine Short
- Department of Medicine, Dalhousie University, Nova Scotia Rehabilitation Centre, Halifax, Nova Scotia, Canada
| | - Karen Ethans
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rebecca Charbonneau
- Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jérôme Paquet
- Neurosurgery, CHU de Québec; Department of Surgery, Université Laval, Québec, Canada
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Cho E, Kim H, Kim J, Lee K, Meghani SH, Chang SJ. Older Adult Residents' Perceptions of Daily Lives in Nursing Homes. J Nurs Scholarsh 2017; 49:495-503. [PMID: 28605167 PMCID: PMC5599958 DOI: 10.1111/jnu.12314] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to explore older adults' perceptions of their daily lives in South Korean nursing homes. DESIGN We employed a qualitative descriptive study using semistructured interviews. METHODS We conducted individual, semistructured interviews with 21 older adult residents from five nursing homes in South Korea and analyzed the data using thematic analysis. FINDINGS Five themes related to older adults' perceptions of their daily lives in nursing homes emerged: enhanced comfort, aspiring to maintain physical and cognitive functions as human beings, desire for meaningful interpersonal relationships, feelings of confinement and limited autonomy, and acceptance of and adaptation to life in a facility. These themes indicated the positive and negative aspects of nursing home residence, and facilitators and challenges to enhancing older adult residents' quality of life (QOL). CONCLUSIONS Policy, practice, and research endeavors are required to improve older adult residents' QOL, such as adequate professional nursing care for physical and psychological comfort and residents' health and functional status, sufficient activity programs and meaningful relationships, person-centered care to enhance residents' autonomy, and homelike environments. CLINICAL RELEVANCE This study demonstrates that healthcare providers, researchers, and policymakers should consider nursing home residents' QOL to examine the quality of care within the setting and facilitate the development of appropriate strategies to improve QOL among this population.
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Affiliation(s)
- Eunhee Cho
- Associate Professor, Yonsei University College of Nursing & Mo-Im Kim Nursing Research Institute, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea
| | - Hyejin Kim
- Post-Doctoral Fellow, Emory University School of Nursing, Atlanta, GA, USA
| | - Jeongah Kim
- Assistant Professor, Seoil University Department of Nursing, Seoul, South Korea
| | - Kyongeun Lee
- Assistant Professor, Tongmyong University Department of Nursing, Busan, South Korea
| | - Salimah H Meghani
- Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Soo Jung Chang
- Assistant Professor, Woosuk University Department of Nursing, Wanju, South Korea
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Björk S, Lindkvist M, Wimo A, Juthberg C, Bergland Å, Edvardsson D. Residents' engagement in everyday activities and its association with thriving in nursing homes. J Adv Nurs 2017; 73:1884-1895. [PMID: 28229474 DOI: 10.1111/jan.13275] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 01/17/2023]
Abstract
AIM To describe the prevalence of everyday activity engagement for older people in nursing homes and the extent to which engagement in everyday activities is associated with thriving. BACKGROUND Research into residents' engagement in everyday activities in nursing homes has focused primarily on associations with quality of life and prevention and management of neuropsychiatric symptoms. However, the mere absence of symptoms does not necessarily guarantee experiences of well-being. The concept of thriving encapsulates and explores experiences of well-being in relation to the place where a person lives. DESIGN A cross-sectional survey. METHOD A national survey of 172 Swedish nursing homes (2013-2014). Resident (n = 4831) symptoms, activities and thriving were assessed by staff using a study survey based on established questionnaires. Descriptive statistics, simple and multiple linear regression, and linear stepwise multiple regression were performed. RESULTS The most commonly occurring everyday activities were receiving hugs and physical touch, talking to relatives/friends and receiving visitors, having conversation with staff not related to care and grooming. The least commonly occurring everyday activities were going to the cinema, participating in an educational program, visiting a restaurant and doing everyday chores. Positive associations were found between activity engagement and thriving, where engagement in an activity program, dressing nicely and spending time with someone the resident likes had the strongest positive association with resident thriving. CONCLUSIONS Engagement in everyday activities can support personhood and thriving and can be conceptualized and implemented as nursing interventions to enable residents to thrive in nursing homes.
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Affiliation(s)
| | - Marie Lindkvist
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Sweden.,Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | | | - Ådel Bergland
- Lovisenberg Diaconal University College, Oslo, Norway
| | - David Edvardsson
- Department of Nursing, Umeå University, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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21
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Wang P, Yap P, Koh G, Chong JA, Davies LJ, Dalakoti M, Fong NP, Tiong WW, Luo N. Quality of life and related factors of nursing home residents in Singapore. Health Qual Life Outcomes 2016; 14:112. [PMID: 27464566 PMCID: PMC4964280 DOI: 10.1186/s12955-016-0503-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/29/2016] [Indexed: 11/29/2022] Open
Abstract
Background Litter is known about the well-being of nursing home (NH) residents in Singapore. This study aimed to identify predictors of self-reported quality of life (QOL) of NH residents in Singapore. Methods In face-to-face interviews, trained medical students assessed each consenting resident recruited from 6 local NHs using a modified Minnesota QOL questionnaire, and rating scales and questions assessing independence, cognitive function, depression, and communication. Predictors of residents’ QOL in five aspects (comfort, dignity, food enjoyment, autonomy, and security) were identified using the censored least absolute deviations (CLAD) models. Results A total of 375 residents completed the interviews. A higher score on comfort was negatively associated with major depression while a higher score on dignity was positively associated with no difficulty in communication with staff. Higher scores in food enjoyment were negatively associated with major depression and poorer cognitive function. Higher scores in autonomy were negatively associated with major depression, greater dependence, and difficulty in communication with staff. A higher score on security were negatively associated with major depression. Conclusion It appears that depression and difficulty in communication with staff are the two main modifiable risk factors of poor quality of life of local NH residents.
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Affiliation(s)
- Pei Wang
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir Foundation Building, Singapore, Singapore
| | - Philip Yap
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - Gerald Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir Foundation Building, Singapore, Singapore
| | | | | | | | - Ngan Phoon Fong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir Foundation Building, Singapore, Singapore
| | | | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir Foundation Building, Singapore, Singapore.
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An intervention targeting fundamental values among caregivers at residential facilities: effects of a cluster-randomized controlled trial on residents' self-reported empowerment, person-centered climate and life satisfaction. BMC Geriatr 2016; 16:130. [PMID: 27387954 PMCID: PMC4936112 DOI: 10.1186/s12877-016-0306-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 06/24/2016] [Indexed: 12/02/2022] Open
Abstract
Background In Sweden the national fundamental values for care of older people state that care should ensure that they can live in dignity and with a sense of well-being. Our hypothesis was that a caregiver intervention targeting the national fundamental values would improve perceived empowerment, person-centered climate and life satisfaction among older people living in residential facilities. Methods The study was a cluster-randomized controlled trial with a pre- and one post-test design, conducted in 27 units (17 study units) at 12 residential facilities for older people in five municipalities in central Sweden. The units in each municipality were randomly assigned to intervention or control group. The caregiver intervention was carried out using an interpretative approach with eight guided face-to-face seminars, where self-reflection and dialogue were used. Data were collected using questionnaires. The number of residents was 43 (78 %) in the intervention group and 37 (71 %) in the control group. The Chi-square test and Mann-Whitney U-tests were performed to detect differences between groups and Wilcoxon signed rank tests to explore differences in change over time within groups. Furthermore, generalized estimating equation (GEE) models were used to study effects of the intervention controlling for clustering effects. Results Primary outcome measures were empowerment, person-centered climate and life satisfaction. In the intervention group, improvements at follow-up were found in residents’ self-reported empowerment (n = 42; p = 0.001, Median difference 4.0, 95 % CI 1.5;6.0), person-centered climate (n = 42; p ≤0.001, Median difference 8.0, 95 % CI 4.5;11.4) and life satisfaction regarding the factor quality of everyday activities (n = 40; p = 0.033, Median difference 9.7, 95 % CI 1.0;21.9) while disempowerment decreased (n = 43; p = 0.018, Median difference -1.3, 95 % CI -2.0;0.0). In the control group person-centered climate decreased (n = 37; p = 0.002, Median difference -8.5, 95 % CI -13.6;-3.0) and quality of everyday activities (n = 36; p = 0.012, Median difference -11.6, 95 % CI-21.7;-3.4). Change over time between groups was significant for empowerment (p = 0.001, Median difference 6.0, 95 % CI 3.0;9.0), disempowerment (p = 0.006, Median difference -2.0, 95 % CI -4.0;-1.0) and person-centered climate (p ≤ 0.001, Median difference 16.0, 95 % CI 9.7;23.0) and for life satisfaction regarding the factor quality of everyday activities (p = 0.002, Median difference 22.1, 95 % CI 8.2;37.4). Results of GEE confirmed earlier results; revealed interaction effects for empowerment (parameter estimate -5.0, 95 % CI -8.3;-1.8), person-centered climate (parameter estimate -16.7, 95 % CI -22.4;-10.9) and life satisfaction regarding the factor quality of everyday activities (parameter estimate -25.9, 95 % CI -40.3;-11.5). Conclusion When the Swedish national fundamental values were put into practice increases in empowerment, person-centered climate and quality of everyday activities were found among older people with intact cognitive ability living in residential facilities. Limitations to consider are the differences between the two groups at baseline, drop-outs and that neither the data collector nor the outcome assessors were blinded to group assignment of participants. Trial registration The study was registered in ISRCTN92658034 in January 2013.
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Bulamu NB, Kaambwa B, Ratcliffe J. A systematic review of instruments for measuring outcomes in economic evaluation within aged care. Health Qual Life Outcomes 2015; 13:179. [PMID: 26553129 PMCID: PMC4640110 DOI: 10.1186/s12955-015-0372-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/22/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This paper describes the methods and results of a systematic review to identify instruments used to measure quality of life outcomes in older people. The primary focus of the review was to identify instruments suitable for application with older people within economic evaluations conducted in the aged care sector. METHODS Online databases searched were PubMed, Medline, Scopus, and Web of Science, PsycInfo, CINAHL, Embase and Informit. Studies that met the following criteria were included: 1) study population exclusively above 65 years of age 2) measured health status, health related quality of life or quality of life outcomes more broadly through use of an instrument developed for this purpose, 3) used a generic preference based instrument or an older person specific preference based or non-preference based instrument or both, and 4) published in journals in the English language after 2000. RESULTS The most commonly applied generic preference based instrument in both the community and residential aged care context was the EuroQol - 5 Dimensions (EQ-5D), followed by the Adult Social Care Outcomes Toolkit (ASCOT) and the Health Utilities Index (HUI2/3). The most widely applied older person specific instrument was the ICEpop CAPability measure for Older people (ICECAP-O) in both community and residential aged care. CONCLUSION In the absence of an ideal instrument for incorporating into economic evaluations in the aged care sector, this review recommends the use of a generic preference based measure of health related quality of life such as the EQ-5D to obtain quality adjusted life years, in combination with an instrument that has a broader quality of life focus like the ASCOT, which was designed specifically for evaluating interventions in social care or the ICECAP-O, a capability measure for older people.
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Affiliation(s)
- Norma B Bulamu
- Flinders Health Economics Group, School of Medicine, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia.
| | - Billingsley Kaambwa
- Flinders Health Economics Group, School of Medicine, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia.
| | - Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia.
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Gregersen M, Jordansen MM, Gerritsen DL. Overall Quality of Life (OQoL) questionnaire in frail elderly: A study of reproducibility and responsiveness of the Depression List (DL). Arch Gerontol Geriatr 2015; 60:22-7. [DOI: 10.1016/j.archger.2014.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
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Quality of life of older adults in Turkey. Arch Gerontol Geriatr 2014; 59:415-21. [PMID: 25064031 DOI: 10.1016/j.archger.2014.07.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 07/01/2014] [Accepted: 07/03/2014] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to examine the factors affecting the quality of life of the elderly people in Turkey. Three-hundred community-dwelling older adults (Mage=68.35, SD=5.80 years) participated in this study. The quality of life was examined through World Health Organization Quality of Life Questionnaire-Older Adults Module Turkish Version (WHOQOL-OLD Turkish). Analysis of Variances (ANOVA) showed significant age differences in sensory abilities, social participation, and intimacy sub-scale scores. Post hoc Scheffe Test results indicated that elderly people aged 75 years and over differed from other age groups; although their scores in social participation and intimacy were lower; they had higher scores in sensory abilities than those aged 60-65 and 66-74 years. There were significant differences between the educational levels of these elderly people in sensory abilities, autonomy, past-present-and-future activities, social participation, and death-and-dying sub-scales. The autonomy, past-present-and-future activities, social participation, and death-and-dying scores of those with high school education were higher than that of those with secondary school or less education except in sensory abilities scores. There were differences found between the variable of with whom the elderly people lived and of QOL sub-scales of the elderly people's sensory abilities, past-today-and-future activities, death-and-dying, social participation, and intimacy. In addition, the total average score of the QOL sub-scales with the sufficiency of income of the elderly people were interconnected. In conclusion, the findings revealed that gender, age, education, marital status, childbearing, social insurance, health status, living arrangement and income variables are the determinant to improving the quality of life of elderly people.
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Farquhar M, Preston N, Evans CJ, Grande G, Short V, Benalia H, Higginson IJ, Todd, on behalf of MORECare C. Mixed methods research in the development and evaluation of complex interventions in palliative and end-of-life care: report on the MORECare consensus exercise. J Palliat Med 2013; 16:1550-60. [PMID: 24195755 PMCID: PMC3868265 DOI: 10.1089/jpm.2012.0572] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Complex interventions are common in palliative and end-of-life care. Mixed methods approaches sit well within the multiphase model of complex intervention development and evaluation. Generic mixed methods guidance is useful but additional challenges in the research design and operationalization within palliative and end-of-life care may have an impact on the use of mixed methods. OBJECTIVE The objective of the study was to develop guidance on the best methods for combining quantitative and qualitative methods for health and social care intervention development and evaluation in palliative and end-of-life care. METHODS A one-day workshop was held where experts participated in facilitated groups using Transparent Expert Consultation to generate items for potential recommendations. Agreement and consensus were then sought on nine draft recommendations (DRs) in a follow-up exercise. RESULTS There was at least moderate agreement with most of the DRs, although consensus was low. Strongest agreement was with DR1 (usefulness of mixed methods to palliative and end-of-life care) and DR5 (importance of attention to respondent burden), and least agreement was with DR2 (use of theoretical perspectives) and DR6 (therapeutic effects of research interviews). Narrative comments enabled recommendation refinement. Two fully endorsed, five partially endorsed, and two refined DRs emerged. The relationship of these nine to six key challenges of palliative and end-of-life care research was analyzed. CONCLUSIONS There is a need for further discussion of these recommendations and their contribution to methodology. The recommendations should be considered when designing and operationalizing mixed methods studies of complex interventions in palliative care, and because they may have wider relevance, should be considered for other applications.
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Affiliation(s)
- Morag Farquhar
- Primary Care Unit, Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Nancy Preston
- School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, United Kingdom
| | - Catherine J. Evans
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Gunn Grande
- School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, United Kingdom
| | - Vicky Short
- School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, United Kingdom
| | - Hamid Benalia
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Irene J. Higginson
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
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