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Kłosińska U, Leszko M. Do I Have Symptoms of Dementia: A Discursive Study of Awareness and Shame Among People With Advanced Dementia. THE GERONTOLOGIST 2024; 64:gnae067. [PMID: 38835189 DOI: 10.1093/geront/gnae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study explores the narrated experiences of individuals with advanced stages of late-onset dementia, focusing on their diagnosis awareness. Such framing is motivated by 2 reasons. Firstly, there is a lack of consensus regarding the prevalence of anosognosia among people with dementia. Secondly, research on anosognosia often neglects to address the important issues of shame and stigma associated with receiving a dementia diagnosis. RESEARCH DESIGN AND METHODS For this qualitative study, a total of 27 participants ranging in age from 66 to 94 were involved. The data collected were analyzed using textual-oriented discourse analysis. RESULTS Our findings indicated that individuals with dementia struggled to comprehend the medical terminology used to describe their experiences within biomedical standards. The interviewees utilized 5 negative discourses on dementia, which shaped their attitudes toward the condition and people diagnosed with it. These discourses depicted dementia as an illness, negative aging, a devaluation, a burden, and a life tragedy. Moreover, study participants did not outright reject the diagnosis but rather negotiated its acceptance within the context of shame associated with dementia. DISCUSSION AND IMPLICATIONS The concept of anosognosia can serve as a mechanism of social control and stigmatization of people with dementia within the dominant biomedical discourse.
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Affiliation(s)
| | - Magdalena Leszko
- Department of Psychology, Moravian University, Bethlehem, Pennsylvania, USA
- Department of Psychology, University of Szczecin, Szczecin, Poland
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Gui F, Yang J, Wu Q, Liu Y, Zhou J, An N. Enhancing Caregiver Empowerment Through the Story Mosaic System: Human-Centered Design Approach for Visualizing Older Adult Life Stories. JMIR Aging 2023; 6:e50037. [PMID: 37962517 PMCID: PMC10662670 DOI: 10.2196/50037] [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: 06/18/2023] [Revised: 09/07/2023] [Accepted: 09/22/2023] [Indexed: 11/15/2023] Open
Abstract
Background Various older adult care settings have embraced the use of the life story approach to enhance the development of comprehensive care plans. However, organizing life stories and extracting useful information is labor-intensive, primarily due to the repetitive, fragmented, and redundant nature of life stories gathered from everyday communication scenarios. Existing life story systems, while available, do not adequately fulfill the requirements of users, especially in the application of care services. Objective The objective of this study is to design, develop, and evaluate a digital system that provides caregivers with the necessary tools to view and manage the life stories of older adults, enabling expedited access to pertinent information effectively and visually. Methods This study used a multidisciplinary, user-centered design approach across 4 phases: initial design requirements, prototyping, prototype refinement workshops, and usability testing. During the initial phase, we conducted field research in the Hefei Tianyu Senior Living Service Nursing Home, China, to discover how caregivers currently store and use life stories and their needs, challenges, and obstacles in organizing and retrieving information. Subsequently, we designed a low-fidelity prototype according to the users' requirements. A prototyping workshop involving 6 participants was held to collaboratively design and discuss the prototype's function and interaction. User feedback from the workshops was used to optimize the prototype, leading to the development of the system. We then designed 2 rounds of usability testing with 7 caregivers to evaluate the system's usability and effectiveness. Results We identified 3 categories of functionalities that are necessary to include in the design of our initial low-fidelity prototype of life story visualizations: life story input, life story organization, and timeline generation. Subsequently, through the workshops, we identified 3 categories for functional optimization: feedback on user interface and usability, optimization suggestions for existing features, and the request for additional functionalities. Next, we designed a medium-fidelity prototype based on human-centered design. The Story Mosaic system underwent usability testing in the Hefei Tianyu Senior Living Service Nursing Home. Overall, 7 users recorded and organized 1123 life stories of 16 older adults. The usability testing results indicated that the system was accessible and easy to use for caregivers. Based on the feedback from the usability testing, we finalized the high-fidelity prototype. Conclusions We designed, developed, and evaluated the Story Mosaic system to support the visual management of older adults' life stories. This system empowers caregivers through digital technology and innovative design, pioneering personal narrative integration in caregiving. This system can expand to include informal caregivers and family members for continued adaptability and empathy.
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Affiliation(s)
- Fang Gui
- Key Laboratory of Knowledge Engineering with Big Data, Ministry of Education, Hefei, China
- School of Computer Science and Information Engineering, Hefei University of Technology, Hefei, China
| | - Jiaoyun Yang
- Key Laboratory of Knowledge Engineering with Big Data, Ministry of Education, Hefei, China
- School of Computer Science and Information Engineering, Hefei University of Technology, Hefei, China
| | - Qilin Wu
- School of Computer Science and Artificial Intelligence, Chaohu University, Hefei, China
| | - Yang Liu
- Key Laboratory of Knowledge Engineering with Big Data, Ministry of Education, Hefei, China
- School of Computer Science and Information Engineering, Hefei University of Technology, Hefei, China
| | - Jia Zhou
- Department of Industrial Engineering, Chongqing University, Chongqing, China
| | - Ning An
- Key Laboratory of Knowledge Engineering with Big Data, Ministry of Education, Hefei, China
- School of Computer Science and Information Engineering, Hefei University of Technology, Hefei, China
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Kłosińska U, Leszko M. Family relationships as a source of narrative identity of people with advanced dementia. BMC Geriatr 2023; 23:546. [PMID: 37684570 PMCID: PMC10492413 DOI: 10.1186/s12877-023-04258-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The growing body of research on narrative identity, while helpful, rarely focuses on people with dementia. In this paper, we explore how individuals living with advanced dementia construct their narrative identities in relation to their family experiences, which play a crucial role in shaping identity as shown by recent studies. METHODS We conducted a qualitative study using data from 15 semi-structured interviews with people aged 66 to 94 who have advanced dementia. The data were analyzed using a textual-oriented discourse analysis. RESULTS We identified two discourses-autobiographical and economic-that organize their narrative identities. Through the autobiographical discourse, participants emphasized their sense of belonging within a social group and their role as custodians of family identity. Within the economic discourse, they negotiated their social utility and value, particularly in response to demeaning discourses targeting individuals who do not accumulate wealth. In the structural analysis, we identified two narrative types-looped or unfolding-that depend on their affective experiences related to their family. We especially explored how the repetition of narrative threads by individuals with dementia might indicate a traumatic background rather than just memory disruptions. CONCLUSIONS This study provides insights into the narrative identities of individuals with advanced dementia, shedding light on the intersection of family experiences and identity formation in this population.
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Affiliation(s)
- Urszula Kłosińska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, ul. Ostrowskiego 30B, Wrocław, 53-238, Poland.
| | - Magdalena Leszko
- Department of Psychology, University of Szczecin, Szczecin, Poland
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Leland NE, Shier V, Piersol CV, Lekovitch C, Martínez J, Bae-Shaaw YH, Sood N, Day C, Cass P, Como D, Wong C, Chew F. Evaluating non-pharmacological approaches to nursing home dementia care: A protocol. Contemp Clin Trials Commun 2023; 34:101161. [PMID: 37347001 PMCID: PMC10266886 DOI: 10.1016/j.conctc.2023.101161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/23/2023] Open
Abstract
Background The COVID-19 pandemic has underscored the daily challenges nursing home (NH) staff face caring for the residents living with Alzheimer's Disease and Related Dementias (ADRD). Non-pharmacological approaches are prioritized over off-label medication to manage the behavioral and psychological symptoms of ADRD. Yet, it is not clear how to best equip NH staff and families with the knowledge and strategies needed to provide non-pharmacological approaches to these residents. Methods This clustered randomized trial will compare team- and problem-based approaches to non-pharmacological ADRD care. The team-based approach includes core training for all NH staff using a common language and strategies to support continuity and sustainability. The problem-based approach capitalizes on the expertise of the professional healthcare providers to target issues that arise. A convergent mixed methods design will be used to examine (a) comparative effectiveness of the two approaches on long-term NH resident outcomes and (b) whether either approach is protective against the negative consequences of COVID-19. The primary outcome is the percentage of ADRD residents with off-label antipsychotic medication use, which will be evaluated with an intent-to-treat approach. Staff and family caregiver perspectives will be explored using a multiple case study approach. Conclusion This trial will be the first-ever evaluation of team- and problem-based approaches to ADRD care across multiple NHs and geographic regions. Results can provide health system leaders and policymakers with evidence on how to optimize ADRD training for staff in an effort to enhance ADRD care delivery.
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Affiliation(s)
- Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Catherine Verrier Piersol
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Cara Lekovitch
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jenny Martínez
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Neeraj Sood
- University of Southern California, Los Angeles, CA, USA
| | - Claire Day
- Alzheimer's Association Northern California and Northern Nevada Chapter, San Jose, CA, USA
| | - Paul Cass
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- University of Southern California, Los Angeles, CA, USA
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
- Alzheimer's Association Northern California and Northern Nevada Chapter, San Jose, CA, USA
| | - Dominique Como
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carin Wong
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Felicia Chew
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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Nocivelli B, Shepherd V, Hood K, Wallace C, Wood F. Identifying barriers and facilitators to the inclusion of older adults living in UK care homes in research: a scoping review. BMC Geriatr 2023; 23:446. [PMID: 37474927 PMCID: PMC10360346 DOI: 10.1186/s12877-023-04126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND With an ageing population, older adults will have more complex health and social care needs and many of these older adults will be living in care homes. Despite the growth in care home populations, care home residents are often excluded from research that could potentially benefit their care. The purpose of this scoping review is to explore resident-related barriers and facilitators to including older people living in UK care homes in research and to identify potential approaches to modify such barriers. METHOD The 6-stage scoping review methodology framework proposed by Arksey and O'Malley guided this review. Five electronic databases (MedLine, PsychINFO, Scopus, Web of Science, CINAHL) and grey literature were searched. Identified articles went through two levels of screening, and those deemed relevant were collated, summarised and reported using a thematic analysis approach. RESULTS 90 reports were eligible for inclusion and were synthesised into 7 themes and related subthemes: (1) research design; (2) understanding and beliefs about research (resident and care home staff); (3) communication; (4) relationships; (5) eligibility criteria (resident and care home); (6) preference-based decisions; and (7) care home staff and environment. Given the complex interplay of the factors identified, both direct and indirect factors were included. CONCLUSIONS A number of recurring barriers and facilitators to the inclusion of care home residents in research are reported. However, isolating resident-related barriers was complex as both direct and indirect factors must be considered as influential. Understanding the barriers and facilitators to inclusion will enable these factors to be addressed and increase the evidence-base for care provided to older people living in care homes.
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Affiliation(s)
- Brittany Nocivelli
- Division of Population Medicine, PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, Wales.
| | - Victoria Shepherd
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales
| | - Kerenza Hood
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales
| | - Carolyn Wallace
- School of Care Sciences, University of South Wales, Newport, Wales
| | - Fiona Wood
- Division of Population Medicine, PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, Wales
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Kłosińska U, Ziółkowska J. Discourses of work life in narrative identities of people with advanced dementia. Int J Geriatr Psychiatry 2023; 38:e5921. [PMID: 37173832 DOI: 10.1002/gps.5921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES There is no consensus as to whether people with advanced dementia can create a narrative identity. It is most often thought to be disturbed due to autobiographical memory disorders. In this paper, we examined how people with advanced dementia constructed their narrative identities in relation to their professional experience. METHODS This qualitative study used data obtained from 8 semi-structured interviews. The interviewees were people with advanced dementia aged between 66 and 89 years. We analyzed the dataset based on the textual-oriented discourse analysis. RESULTS The study participants created narrative identities. Their narrative identities were constructed within residual professional discourses learned during their lifespan. These discourses blended their narrative identities into coherent stories about who they are now, offered languages to describe current experiences, and emphasized important values for their self-image. The participants built narrative identities by referring to the past and imagining a better present with the omission of the future. The past was valued positively and was a source of positive nostalgia. Projections of a better present served to reveal their needs and assess ways to meet them. CONCLUSIONS We argue that people with advanced dementia can create complex and coherent narrative identities. They are constructed around discourses and not only using autobiographical memories. Encouraging them to create narrative identities in the dialogue can be a simple therapeutic method by which they can maintain a sense of self-cohesion and belonging to the world.
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Affiliation(s)
- Urszula Kłosińska
- SWPS University of Social Sciences and Humanities, Faculty of Psychology, Wrocław, Poland
| | - Justyna Ziółkowska
- SWPS University of Social Sciences and Humanities, Faculty of Psychology, Wrocław, Poland
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Nimmons D, Manthorpe J, West E, Rait G, Sampson EL, Iliffe S, Davies N. Views of people living with dementia and their carers on their present and future: a qualitative study. BMC Palliat Care 2023; 22:38. [PMID: 37032342 PMCID: PMC10084652 DOI: 10.1186/s12904-023-01165-w] [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: 10/28/2022] [Accepted: 04/03/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Dementia leads to multiple issues including difficulty in communication and increased need for care and support. Discussions about the future often happen late or never, partly due to reluctance or fear. In a sample of people living with dementia and carers, we explored their views and perceptions of living with the condition and their future. METHODS Semi-structured interviews were conducted in 2018-19 with 11 people living with dementia and six family members in England. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis. RESULTS Findings were explored critically within the theory of social death and three themes were developed: (1) loss of physical and cognitive functions, (2) loss of social identity, and (3) social connectedness. Most participants living with dementia and carers wanted to discuss the present, rather than the future, believing a healthy lifestyle would prevent the condition from worsening. Those with dementia wanted to maintain control of their lives and demonstrated this by illustrating their independence. Care homes were often associated with death and loss of social identity. Participants used a range of metaphors to describe their dementia and the impact on their relationships and social networks. CONCLUSION Focusing on maintaining social identity and connectedness as part of living well with dementia may assist professionals in undertaking advance care planning discussions.
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Affiliation(s)
- Danielle Nimmons
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK.
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Emily West
- Division of Psychiatry, Marie Curie Palliative Care Research Department, Centre for Dementia Palliative Care Research, UCL, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Elizabeth L Sampson
- Division of Psychiatry, Marie Curie Palliative Care Research Department, Centre for Dementia Palliative Care Research, UCL, London, UK
- Barnet, Enfield and Haringey Mental Health Liaison Service, North Middlesex University Hospital NHS Trust, London, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Nathan Davies
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
- Division of Psychiatry, Marie Curie Palliative Care Research Department, Centre for Dementia Palliative Care Research, UCL, London, UK
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Orr N, Abbott R, Bethel A, Paviour S, Whear R, Garside R, Coon JT. What are the effects of animals on the health and wellbeing of residents in care homes? A systematic review of the qualitative and quantitative evidence. BMC Geriatr 2023; 23:170. [PMID: 36964508 PMCID: PMC10038779 DOI: 10.1186/s12877-023-03834-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/16/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND There is some evidence to suggest that animal-assisted interventions can have beneficial impact for residents in long-term care, but the focus of the evidence has largely been on behavioural and psychosocial measured outcomes. Animals, either as companion animals or in the form of pet/animal-assisted therapy, may provide benefits in the form of social contact, as well as opportunities for sensory experiences and meaningful engagement not picked up by outcome tools. This review aimed to create a state-of-knowledge synthesis, bringing together qualitative and quantitative findings, on the impact of animal-human interaction on care home residents and care home staff. METHODS Fourteen databases were searched from inception to July 2020. Forward and backward citation chasing of included articles was conducted. Screening was undertaken independently by a team of reviewers. Thematic synthesis and meta-analysis were used to synthesise the qualitative and quantitative data. RESULTS Thirty-four studies, published in 40 articles (20 qualitative and 20 quantitative) were included. Five themes relating to resident wellbeing were identified in the qualitative evidence synthesis. These were animals as 'living beings', reminiscence and storytelling, caring (as 'doing' and 'feeling'), respite (from loneliness, institutionalisation, and illness), and sensory engagement. A sixth theme related to staff perceptions and wellbeing, and a seventh to animal health and wellbeing. Maintaining identity was identified as an overarching theme. The majority of randomised trials had small sample sizes and were rated as low quality, mostly showing no evidence of beneficial effect. There was, however, limited evidence of a positive effect of pet/animal interaction on outcomes of loneliness, anxiety and depression, supporting the themes of respite and sensory engagement. CONCLUSIONS The presence of animals can significantly impact the health and wellbeing of some care home residents. Residents had meaningful relationships with animals and derived pleasure and comfort from them. Interacting with animals offered residents a way to maintain a sense of self in the care homes, and with support, residents with dementia could also express their identities. Facilitating residents to interact with animals as part of person-centred care may also help residents to feel 'at home' in the care home. TRIAL REGISTRATION PROSPERO registration no: CRD42017058201.
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Affiliation(s)
- Noreen Orr
- NIHR ARC South West Peninsula (PenARC), College of Medicine & Health, Evidence Synthesis Team, University of Exeter, South Cloisters, St. Luke's Campus, Exeter, EX1 2LU, Devon, UK.
| | - Rebecca Abbott
- NIHR ARC South West Peninsula (PenARC), College of Medicine & Health, Evidence Synthesis Team, University of Exeter, South Cloisters, St. Luke's Campus, Exeter, EX1 2LU, Devon, UK
| | - Alison Bethel
- NIHR ARC South West Peninsula (PenARC), College of Medicine & Health, Evidence Synthesis Team, University of Exeter, South Cloisters, St. Luke's Campus, Exeter, EX1 2LU, Devon, UK
| | - Sarah Paviour
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- NIHR ARC South West Peninsula (PenARC), College of Medicine & Health, Evidence Synthesis Team, University of Exeter, South Cloisters, St. Luke's Campus, Exeter, EX1 2LU, Devon, UK
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical School, Royal Cornwall Hospital, Knowledge Spa, Truro, Cornwall, TR1 3HD, UK
| | - Joanna Thompson Coon
- NIHR ARC South West Peninsula (PenARC), College of Medicine & Health, Evidence Synthesis Team, University of Exeter, South Cloisters, St. Luke's Campus, Exeter, EX1 2LU, Devon, UK
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Naruse T, Hatsushi M, Tsuchiya-Ito R, Kobayashi M, Kato J. Experiences of Disabled Older Adults in Urban Area Adult Day Care Centers: A Multisite Case Study. Gerontol Geriatr Med 2023; 9:23337214231156304. [PMID: 36814693 PMCID: PMC9940214 DOI: 10.1177/23337214231156304] [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: 11/28/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 02/20/2023] Open
Abstract
This study described clients' experiences within adult day care (ADC) and its related impacts. A multisite case study was conducted with 26 older adults from six ADCs in Tokyo, with interviews and field observations conducted between November 2020 and July 2022. The transcribed interviews and field notes were analyzed qualitatively. Three categories pertaining to context ("guilt and resignation to the current living conditions," "desire for social connection despite frustrating limitations," and "supported life based on weekly ADC routine") and four categories about the experiences within ADC ("savoring disability- and age-friendly conversations," "feeling happy about something new and positive," "challenges for changes in self-image," and "discomfort with others and the waste of time") were extracted. Clients' increased vulnerability due to disabilities and COVID-19 affected their experiences. ADCs provide a safe place for interaction, and their use must be encouraged to develop a disability- and age-friendly society.
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Affiliation(s)
- Takashi Naruse
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Japan,Takashi Naruse, Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | | | - Rumiko Tsuchiya-Ito
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | | | - Junichi Kato
- Long-Term Care Health Facility, Peace Plaza, Seishinkai Medical Corporation, Tokyo, Japan
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Egan C, Naughton C, Caples M, Mulcahy H. Shared decision-making with adults transitioning to long-term care: A scoping review. Int J Older People Nurs 2023; 18:e12518. [PMID: 36480119 PMCID: PMC10078233 DOI: 10.1111/opn.12518] [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: 05/13/2022] [Revised: 10/06/2022] [Accepted: 10/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transitions to long-term care are challenging for individuals and often associated with a loss of autonomy. Positive experiences are noted, especially when decisions involve the individual in a person-centred way which are respectful of the person's human rights. One approach which facilitates self-determination during a transitional period is shared decision-making, but there is a lack of clarity on the nature and extent of research evidence in this area. OBJECTIVE The purpose of this scoping review is to identify and document research related to shared decision-making and transitioning to long-term care. METHODS A comprehensive search in CINAHL, Medline and Psych-info identified papers which included evidence of shared decision-making during transitions to a long-term care setting. The review following the JBI and PAGER framework for scoping reviews. Data were extracted, charted and analysed according to patterns, advances, gaps, research recommendations and evidence for practice. RESULTS Eighteen papers met the inclusion criteria. A body of knowledge was identified encompassing the pattern advancements in shared decision-making during transitions to long-term care, representing developments in both the evidence base and methodological approaches. Further patterns offer evidence of the facilitators and barriers experienced by the person, their families and the professional's involved. CONCLUSIONS The evidence identified the complexity of such decision-making with efforts to engage in shared decision-making often constrained by the availability of resources, the skills of professionals and time. The findings recognise the need for partnership and person-centred approaches to optimise transitions. The review demonstrates evidence of approaches that can inform future practice and research to support all adult populations who may be faced with a transitional decision to actively participate in decision-making.
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Affiliation(s)
- Caroline Egan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Corina Naughton
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Maria Caples
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Helen Mulcahy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Søvde BE, Sandvoll AM, Natvik E, Drageset J. Carrying on life at home or moving to a nursing home: frail older people’s experiences of at-homeness. Int J Qual Stud Health Well-being 2022; 17:2082125. [DOI: 10.1080/17482631.2022.2082125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Bente Egge Søvde
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
- Department of Global Public Health and Primary Care, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Anne Marie Sandvoll
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
| | - Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
| | - Jorunn Drageset
- Department of Global Public Health and Primary Care, University of Bergen Faculty of Medicine, BERGEN, Norway
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Campus Bergen, Bergen, Norway
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Naruse T, Hatsushi M, Kato J. Experiences of Disabled Older Adults in Tokyo's Adult Day Care Centers during COVID-19-A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095356. [PMID: 35564750 PMCID: PMC9104431 DOI: 10.3390/ijerph19095356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic resulted in social isolation among elderly people with disabilities. Adult daycare (ADC) is an important community care option for socialization among people with disabilities. However, their experiences with ADC remain underexplored. Thus, this study investigated the experiences of community-dwelling disabled elderly with ADC from the perspective of socialization. Four older women from Tokyo with disabilities, availing of one ADC service, were interviewed across two sessions between November 2020 and January 2021. The transcribed interviews and field notes were analyzed qualitatively. This yielded eight categories: two pertaining to context ("restricted social interaction outside of ADC", "feeling simultaneously grateful and ashamed of oneself as a recipient of care services"), and six pertaining to experience with ADC ("take a catastrophic defensive posture in situations where one's perception of value is shaken", "express oneself positively to justify one's daily life", "have trouble knowing what to do", "put oneself in a shaded exchange relationship", "examine the value of elderly people in need of care in society", and "savor regular contact with others"). Ensuring the use of ADC as a safe place for interaction while considering pandemic-related needs is important to develop policy and practical responses to restricted socialization during COVID-19.
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Affiliation(s)
- Takashi Naruse
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
- Correspondence:
| | - Masakazu Hatsushi
- Hakononakanohako, General Incorporated Association, Tokyo 140-0001, Japan;
| | - Junichi Kato
- Long-Term Care Health Facility, Peace Plaza, Seishinkai Medical Corporation, Tokyo 183-0021, Japan;
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Johnson IG, Morgan MZ, Jones RJ. Oral care, loss of personal identity and dignity in residential care homes. Gerodontology 2022; 40:200-206. [PMID: 35445763 DOI: 10.1111/ger.12633] [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: 06/14/2021] [Revised: 12/23/2021] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The UK National Institute of Clinical Excellence (NICE) guidelines recommend that care staff who provide daily personal care to residents: "Understand the importance of residents' oral health and the potential effect on their general health, well-being and dignity." The aim of this study was to explore residents' views and perspectives of dental care in care homes in order to understand how to deliver this care. METHOD Care homes were identified using care home inspection reports for Wales, the UK. Care homes for older people with residents having mental capacity to consent were invited to participate. Data were collected using semi-structured one-to-one interviews with care home residents, care home managers and oral healthcare leads. Interviews were audio recorded, transcribed and analysed using a thematic approach to data. Analysis was assisted by NVivo 10 software. Data collection was completed when no new themes emerged. RESULTS This analysis presents findings from 26 interviews with residents, across five care homes. Going into care was associated with a loss of identity. Having teeth and looking after teeth (natural teeth or dentures) was part of keeping that identity. All prioritised privacy, pride and independence above effective oral hygiene. Oral hygiene was viewed as a very private event. Carers adapted oral care, to balance time constraints, care, privacy and dignity. Teeth were a part of personal pride to the extent that two residents said they did not want to die without dentures in their mouths. CONCLUSION Whilst oral care is important to residents, dignity and privacy are often more important; care routines and practices are adapted around this. Carers need to adopt an individualised, pragmatic and sensitive approach to oral care to account for personal dignity when looking after residents to be able to provide appropriate oral care in accordance with guidance. Members of the dental team need to support carers to provide effective oral care, which allows dignified and effective care.
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Affiliation(s)
- Ilona G Johnson
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Maria Z Morgan
- Applied Clinical and Public Health Research, Cardiff University School of Dentistry, Cardiff, UK
| | - Rhiannon J Jones
- Department of Education, Scholarship and Innovation (DESI), Cardiff University, School of Dentistry, Cardiff, UK
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14
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O’Neill M, Ryan A, Tracey A, Laird L. 'The Primacy of 'Home': An exploration of how older adults' transition to life in a care home towards the end of the first year. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e478-e492. [PMID: 33242367 PMCID: PMC9292794 DOI: 10.1111/hsc.13232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/18/2020] [Accepted: 10/20/2020] [Indexed: 05/12/2023]
Abstract
This grounded theory study sought to explore how older adults' experience the transition from living at home to a care home with a specific focus on the latter part of the first year of the move. The study was carried out within a large Health Trust in the UK between August 2017 and May 2019. Purposive sampling was used in the initial stages of data collection. Thereafter and consistent with grounded theory methodology, theoretical sampling was employed to undertake semi-structured interviews with 17 individuals from eight care homes between 5 and 12 months after the move. This paper reports five key categories which were: (a) The lasting effect of first Impressions 'They helped me make my mind up' (b) On a Journey 'I just take it one day at a time', (c) Staying connected and feeling 'at home' 'You get something good out of it you know…you get hope'. (d) Managing loss and grief 'It was important for me to say cheerio to the house' and (e) Caring relationships 'I didn't realise that I was lonely until I had company'. Together these five categories formed the basis of the core category 'The Primacy of 'Home' which participants identified as a place they would like to feel valued, nurtured and have a sense of belonging. This study identifies that it is important for individual preferences and expectations to be managed from the outset of the move. Individuals and families need to be supported to have honest and caring conversations to promote acceptance and adaptation to living in a care home while continuing to embrace the heart of 'home'. Key recommendations from this study include the need to raise awareness of the significance of the ongoing psychological and emotional well-being needs of older people which should be considered in policy directives and clinical practice.
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Affiliation(s)
- Marie O’Neill
- School of Nursing and Institute of Nursing and Health ResearchUlster UniversityCo LondonderryNorthern Ireland
| | - Assumpta Ryan
- School of Nursing and Institute of Nursing and Health ResearchUlster UniversityCo LondonderryNorthern Ireland
| | - Anne Tracey
- School of PsychologyUlster UniversityColeraine, Co LondonderryNorthern Ireland
| | - Liz Laird
- School of Nursing and Institute of Nursing and Health ResearchUlster UniversityCo LondonderryNorthern Ireland
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15
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Stargatt J, Bhar S, Bhowmik J, Al Mahmud A. Digital Storytelling for Health-Related Outcomes in Older Adults: Systematic Review. J Med Internet Res 2022; 24:e28113. [PMID: 35019845 PMCID: PMC8792772 DOI: 10.2196/28113] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/28/2021] [Accepted: 10/22/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Older adults face a unique set of challenges and may experience a range of psychological comorbidities. Digital storytelling is an emerging tool for sharing and recording lived experiences and may have the potential to support well-being but is yet to be systematically reviewed for use among older adults. OBJECTIVE The aim of this review is to examine the methods for creating digital stories, the health-related outcomes associated with creating digital stories, and the potential for implementing digital storytelling with older adults. METHODS We systematically searched electronic databases to identify articles published in English that reported on at least one health-related outcome of digital storytelling for participants aged ≥60 years. Data were extracted and synthesized using qualitative content analysis and summarized in tables. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool. RESULTS A total of 8 studies were included in the review. Participants were primarily community-dwelling older adults living with dementia, involving family caregivers and professional care staff. Studies have taken various approaches to digital storytelling and reported diverse benefits associated with digital storytelling, including improvements in mood, memory, social engagement, and quality of relationships. Although the potential for implementation was not widely examined, some studies have presented evidence for acceptability and feasibility. Generally, studies were of high quality, despite the absence of comparator groups and confounder analyses. CONCLUSIONS The evidence reviewed suggests that despite the various approaches taken, digital storytelling shows promise as an effective approach for supporting well-being in older adults. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42019145922; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019145922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/15512.
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Affiliation(s)
- Jennifer Stargatt
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Jahar Bhowmik
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Abdullah Al Mahmud
- Centre for Design Innovation, School of Design, Swinburne University of Technology, Hawthorn, Australia
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16
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Woods T, Nies MA, Shirley AM. Social Networks in Retirement and Assisted Living Communities: A Literature Review. J Gerontol Nurs 2022; 48:42-46. [PMID: 34978489 DOI: 10.3928/00989134-20211207-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research has substantiated that social isolation and loneliness are linked to poorer health, earlier death, and reduced quality of life among older adults. Although there has been research focusing on social networks of nursing home residents and interventions to decrease loneliness and improve social interactions for older adults in varied settings, there is a gap in research relating to social networks of older adults in assisted living and retirement communities. The goal of the current review was to summarize relevant research findings related to this topic published in the past 5 years. The literature review included searching three electronic databases (CINAHL, EBSCOhost, and PubMed) for research articles published between January 2015 and March 2020. A total of 475 articles were identified, which was narrowed to 16 articles included for full review after inclusion and exclusion criteria were applied. Following analysis, three themes were identified in the literature: Social Connections Within an Assisted Living Community, Social Networks Between Residents and Their Adult Children, and Influence of Physical Structure on Social Networks of Residents. [Journal of Gerontological Nursing, 48(1), 42-46.].
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17
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Gautam S, Montayre J, Neville S. Making meaning of the new identity-as-resident: A grounded theory study. Nurs Health Sci 2021; 24:101-112. [PMID: 34741388 DOI: 10.1111/nhs.12899] [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: 05/06/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/28/2022]
Abstract
Residential living has the potential to threaten older adults' established identity. This study utilized grounded theory methodology to explore how older adults make meaning of the new identity-as-resident in a residential aged care facility. Using theoretical sampling, in-depth semi-structured interviews and observation within interviews were conducted with 17 residents from two Nepalese residential aged care facilities. Data analysis involved the process of open, axial, selective coding, and constant comparative analysis as specified by grounded theory methodology. The process that older adults experience in making meaning of their new identity-as-resident involved phases of isolating, exploring, evaluating, and compromising, which led in consequence to internalization of the new identity. Furthermore, it was found that this process depends on the facility structure, rules and regulations, and the attitudes and practices of nurses/caregivers. A focus on these facilitators is crucial for managers and nurses/caregivers working in residential aged care to assist residents in constructing a positive identity-as-resident. The findings can potentially be beneficial for raising awareness, educating nurses/caregivers, developing policies for promoting a positive identity-as-resident in residential aged care facilities worldwide.
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Affiliation(s)
- Sital Gautam
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Stephen Neville
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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18
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Bhar S, Stargatt J, Collins R, Bhowmik J, Silver M. Preliminary evidence for the impact of digital life stories about aged care residents on staff knowledge and understanding regarding those residents; A single arm trial. J Clin Nurs 2021; 31:2252-2258. [PMID: 34605590 DOI: 10.1111/jocn.16043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/10/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to examine the impact of digital stories about aged care residents on staff knowledge and understanding regarding those residents. BACKGROUND More than a quarter of a million older Australians live in residential aged care facilities. This living arrangement can inhibit the expression of a person's sense of identity. Without objects and cues that reflect the person's selfhood, it can be difficult for a person to express their uniqueness. Staff may not sufficiently appreciate the resident's individuality and therefore may not be able to customise care for the resident. DESIGN This study used a single-arm trial design. METHODS The study was conducted in four residential aged care facilities. Short digital life stories (3-4 min) of eight residents were constructed by student volunteers over 6 months. Participants (n = 53 care staff) completed a self-report measure of their knowledge and understanding of a resident before and after watching the resident's story. The study adhered to guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) (see Appendix S1). RESULTS Pre- and post-test scores of the measure were compared using paired samples t-tests. These scores changed significantly, showing an improvement of knowledge and understanding regarding residents. CONCLUSIONS Watching digital life stories were associated with improvements in knowledge and understanding by staff, and hence have the potential to foster a greater level of understanding of residents by such staff, and more person-centred care practices within residential aged care facilities. RELEVANCE TO CLINICAL PRACTICE Digital stories about aged care residents are quick and efficient methods for improving aged care staff members' knowledge and understanding of the residents under their care. With such understanding, staff may be able to better customise care for residents, thereby validating residents' sense of identity and elevating residents' quality of life.
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Affiliation(s)
- Sunil Bhar
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jennifer Stargatt
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rebecca Collins
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jahar Bhowmik
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Mark Silver
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
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Abstract
The rising aging population in India has led to an increased caregiving burden, and accordingly, the number of residential care facilities is also burgeoning. There is no regulatory framework or registration authority specifically for residential care homes in India. The article's objective is to understand the need for a regulatory framework in India in the context of historic and global experiences in the UK, USA, and Europe. Although there is a lack of literature comparing the community home-based care and residential care, one study reported a preference for home-based care in the South Asian context. Elder abuse and deprivation of rights of seniors are common, and there is a need to bring in more safeguards to prevent these from the perspective of the older adults, their family members, the care providers, and the state. While the main priority of meeting care needs in long-term care is a challenge given the lack of trained care staff, the quality control mechanisms also need to evolve. A review of adverse incidents, complaints, and litigations also highlights the need for regulation to improve the standards and quality of care. The article explores lacunae of residential care facilities in the Indian context and provides recommendatory parameters for evaluating the quality of care provided. Relevant sections of the statutory new Mental Healthcare Act of 2017 in India could provide a regulatory framework ensuring rights and liberties of the residents are upheld. The authors propose a state-run model for elderly care homes and commencement of framing regulations appropriate to the Indian context.
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Affiliation(s)
| | - Mahesh Gowda
- Spandana Healthcare, Nandini Layout, Bangalore, Karnataka, India
| | - Saraswati Tenagi
- Dept. of Psychiatry, Belgaum Institute of Medical Sciences, Belagavi, Karnataka, India
| | - Mina Chandra
- Dept. of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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20
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Harding A, Preston N, Doherty J, Cousins E, Varey S, McCann A, Dening KH, Finucane A, Carter G, Mitchell G, Brazil K. Developing and evaluating online COVID-centric advance care planning training and information resources for nursing staff and family members in nursing homes: the necessary discussions study protocol. BMC Geriatr 2021; 21:456. [PMID: 34372794 PMCID: PMC8350283 DOI: 10.1186/s12877-021-02398-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nursing home residents are typically older adults with high levels of chronic illness and impairment. As such, they are particularly susceptible to severe complications and mortality from COVID-19. Since all nursing home residents are at increased risk, nursing home care staff need to know what residents would want to happen should they become infected with COVID-19. This study aims to develop and evaluate advance care planning (ACP) COVID-centric online training and information resources for nursing home staff and family members of residents, to improve care at the end of life during a COVID-19 outbreak. Based on the findings we will develop implementation guidelines for nursing homes to ensure wider impact and application during the pandemic and beyond. Methods The content of the training and information resources will be based on a rapid review of literature and guidance on ACP in the context of COVID-19 and consultation with the study expert reference group. An integrated communications company will then work alongside the research team to design the online training and information resources. To evaluate the resources, we will employ a multiple case study design where a nursing home (defined as an institutional setting in which nursing care is provided to older adults on-site 24 h a day) will be the unit of analysis or ‘case’. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will guide the evaluation of implementation of the training and information resources. We will recruit and interview staff and family members from between 6 and 9 nursing homes across Northern Ireland, England and Scotland and gather quantitative data from a feedback survey included in the training and information resources. Discussion The Necessary Discussions study is very timely given the challenging experiences of nursing homes, their staff, residents and their family members during the COVID-19 pandemic. It meets a key need and addresses an important gap in research and practice. The training and information resources will be ‘COVID-centric’, but they will also have a longstanding relevance for future ACP practice in UK care homes. Trial registration ISRCTN registry (ID 18003630) on 19.05.21
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Affiliation(s)
- Andrew Harding
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Julie Doherty
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Emily Cousins
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sandra Varey
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Adrienne McCann
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Karen Harrison Dening
- School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester & Dementia UK, London, UK
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh & Marie Curie Hospice Edinburgh, Edinburgh, UK
| | - Gillian Carter
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Gary Mitchell
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK.
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21
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‘Knowing me, knowing you’: an exploration of the views and experiences of nursing home residents and staff on their nursing home as ‘home’. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
The overall aim of this grounded theory study was to explore the context of a nursing home as ‘home’ from the perspective of residents and staff. Sixteen focus group interviews were used to collect qualitative data from nursing home residents (N = 48) and staff (N = 44). Five distinct categories captured the views and experiences of participating residents and staff. These were: (a) Starting off on the right foot, ‘First impressions can be the lasting ones; (b) Making new and maintaining existing connections, ‘There is great unity between staff and residents’; (c) The nursing home as home, ‘It's a bit like home from home for me’; (d) Intuitive knowing, ‘I don't even have to speak, she just knows’; and (e) Feeling at home in a regulated environment, ‘It takes the home away from nursing home’. Together these five categories formed the basis of the core category ‘Knowing me, knowing you’, which captures the experiences of participants who repeatedly highlighted the importance of relationships and feelings of mutuality and respect between and among staff and residents as central to feeling at home in a nursing home. The reciprocity and mutuality associated with the core category, ‘Knowing me, knowing you’, was at times challenged by staff shortages, time constraints, and conflicting priorities associated with the co-existence of a regulated and homely environment.
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22
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Rabiee P, Mann R, Birks Y, Wilberforce M. The experience of loneliness and living with sight loss in English care homes. J Aging Stud 2021; 57:100913. [PMID: 34082991 DOI: 10.1016/j.jaging.2021.100913] [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: 06/08/2020] [Revised: 01/22/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
Loneliness is a serious societal concern, especially the loss of social connections in later life. Those with sight loss living in care homes are thought to face particular challenges in social engagement, but research is scarce. This study aimed to examine the experience of loneliness amongst residents with sight loss; the different dimensions of loneliness; and their attitudes about the role of care homes in addressing these needs. Through in-depth interviews with 18 residents, supplemented by interviews with family members and care home managers, the research identified that residents were generally satisfied with their social situation. However, there was evidence that sight loss was not appropriately accommodated within the care home. In their efforts to enable all residents to engage in social activities, attempts to include those with sight loss could feel contrived, and residents with sight loss did not feel meaningfully involved. Residents described barriers to forming close associations, including the challenges of background noise in communal spaces and a sense that conversation in the care home lacked stimulation. Residents felt that opportunities to forge and maintain bonds with people outside the care home were limited. The research concludes that care homes should avoid inclusion-for-inclusion's sake, and future research could study the effectiveness of interventions to improve care home links to the wider community.
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Affiliation(s)
- Parvaneh Rabiee
- Social Policy Research Unit, Department of Social Policy & Social Work, Alcuin College (B Block), University of York, York YO10 5DD, UK.
| | - Rachel Mann
- Social Policy Research Unit, Department of Social Policy & Social Work, Alcuin College (B Block), University of York, York YO10 5DD, UK.
| | - Yvonne Birks
- Social Policy Research Unit, Department of Social Policy & Social Work, Alcuin College (B Block), University of York, York YO10 5DD, UK.
| | - Mark Wilberforce
- Social Policy Research Unit, Department of Social Policy & Social Work, Alcuin College (B Block), University of York, York YO10 5DD, UK.
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23
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West E, Nair P, Barrado-Martin Y, Walters KR, Kupeli N, Sampson EL, Davies N. Exploration of the impact of the COVID-19 pandemic on people with dementia and carers from black and minority ethnic groups. BMJ Open 2021; 11:e050066. [PMID: 34006561 PMCID: PMC8136797 DOI: 10.1136/bmjopen-2021-050066] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Despite community efforts to support and enable older and vulnerable people during the COVID-19 pandemic, many people with dementia and their family carers are still finding it difficult to adjust their daily living in light of the disruption that the pandemic has caused. There may be needs specific to black, Asian and minority ethnic (BAME) populations in these circumstances that remain thus far unexplored. OBJECTIVE The aim of the study was to explore the effects of the COVID-19 pandemic on people living with dementia and their family carers of BAME backgrounds, in relation to their experiences of community dementia care and the impact on their daily lives. DESIGN 15 participants (persons with dementia and carers) were recruited for semistructured qualitative interviews. Respondents were of South Asian and Afro-Caribbean backgrounds. We used thematic analysis to analyse our data from a constructivist perspective, which emphasises the importance of multiple perspectives, contexts and values. RESULTS There were a number of ways that the COVID-19 pandemic has impacted BAME persons with dementia and carers with regard to their experiences of dementia community care and the impact on their everyday lives. In particular we identified eight key themes, with subthemes: fear and anxiety, food and eating (encompassing food shopping and eating patterns), isolation and identity, community and social relationships, adapting to COVID-19, social isolation and support structures, and medical interactions. Fear and anxiety formed an overarching theme that encompassed all others. DISCUSSION This paper covers unique and underexplored topics in a COVID-19-vulnerable group. There is limited work with these groups in the UK and this is especially true in COVID-19. The results showed that such impacts were far-reaching and affected not only day-to-day concerns, but also care decisions with long-ranging consequences, and existential interests around fear, faith, death and identity.
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Affiliation(s)
- Emily West
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Pushpa Nair
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Kate R Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Nathan Davies
- Department of Primary Care and Population Health, University College London, London, UK
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Abstract
PURPOSE OF REVIEW The WHO updated concept of health includes social health alongside physical and mental health. No existing reviews have examined the evidence for preserving or enhancing social health in people living with neurocognitive disorders, such as mild cognitive impairment and dementia. The present review examines recent epidemiological studies and interventions with social health outcome measures, including interventions across multiple modalities and settings, from communities to assisted living facilities. RECENT FINDINGS Epidemiological evidence shows that neurocognitive disorders are associated with poorer social support, and greater social isolation and loneliness. This highlights the importance of maintaining and enhancing social health in people living with neurocognitive disorders. Group activities involving dance or music have emerging evidence indicating improvements in social health in communities and assisted living facilities. More quantitative research is required on the social health benefits of cognitive/multicomponent interventions, community social groups, exercise groups and other interventions. Several socially assistive robots are being developed to help foster social participation and require further research. SUMMARY There is evidence that group music or dance interventions can improve social health for people living with neurocognitive disorders. Larger trials with multiple social health outcome measures are required to investigate the social health benefits of exercise, cognitive/multicomponent and community social group interventions.
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25
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Ludlow K, Churruca K, Mumford V, Ellis LA, Braithwaite J. Aged care residents' prioritization of care: A mixed-methods study. Health Expect 2021; 24:525-536. [PMID: 33477203 PMCID: PMC8077118 DOI: 10.1111/hex.13195] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/14/2020] [Accepted: 12/24/2020] [Indexed: 12/27/2022] Open
Abstract
Background Eliciting residents’ priorities for their care is fundamental to delivering person‐centred care in residential aged care facilities (RACFs). Prioritization involves ordering different aspects of care in relation to one another by level of importance. By understanding residents’ priorities, care can be tailored to residents’ needs while considering practical limitations of RACFs. Objectives To investigate aged care residents’ prioritization of care. Design A mixed‐methods study comprising Q methodology and qualitative methods. Setting and participants Thirty‐eight residents living in one of five Australian RACFs. Method Participants completed a card–sorting activity using Q methodology in which they ordered 34 aspects of care on a pre‐defined grid by level of importance. Data were analysed using inverted factor analysis to identify factors representing shared viewpoints. Participants also completed a think‐aloud task, demographic questionnaire, post‐sorting interview and semi‐structured interview. Inductive content analysis of qualitative data was conducted to interpret shared viewpoints and to identify influences on prioritization decision making. Results Four viewpoints on care prioritization were identified through Q methodology: Maintaining a sense of spirituality and self in residential care; information sharing and family involvement; self‐reliance; and timely access to staff member support. Across the participant sample, residents prioritized being treated with respect, the management of medical conditions, and their independence. Inductive content analysis revealed four influences on prioritization decisions: level of dependency; dynamic needs; indifference; and availability of staff. Conclusions Recommendations for providing care that align with residents’ priorities include establishing open communication channels with residents, supporting residents’ independence and enforcing safer staffing ratios.
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Affiliation(s)
- Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Hämel K, Röhnsch G. Between Social Inclusion and Exclusion: Integration of Daycare Guests in the Nursing Home Setting. THE GERONTOLOGIST 2020; 61:1030-1040. [PMID: 33034645 PMCID: PMC8437502 DOI: 10.1093/geront/gnaa157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives In integrated daycare, community-dwelling older people in need of care join existing groups in residential care facilities during the day. This study focuses on how nursing home residents experience the integrative care approach, exploring opportunities for social inclusion and mechanisms of exclusion. Research Design and Methods A purposive sample of residents differing in cognitive capacity and level of (non)conflictual interaction with daycare guests was selected. Episodic interviews with residents (N = 10) and close relatives (N = 2) were conducted in 3 pilot facilities in Germany and analyzed using thematic coding. Results The analysis revealed different orientation patterns towards the presence of daycare guests: respondents (a) demonstrated indifference to the daycare guests, (b) saw bonding with guests as a means to connect to the outside world, and (c) perceived incompatibility between in-group and out-group. Criticisms included disruption of daily routines and loss of privacy. Most interviewees came to terms with the care situation using rational and moral arguments. Discussion and Implications The study reveals the importance of residents’ participation when integrating daycare guests. Institutional procedures are required to prevent exclusion of daycare guests and avoid overtaxing residents.
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Affiliation(s)
- Kerstin Hämel
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Gundula Röhnsch
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
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‘Waiting and Wanting’: older peoples’ initial experiences of adapting to life in a care home: a grounded theory study. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20000872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractA grounded theory approach, consistent with the work of Strauss and Corbin, was used to undertake semi-structured interviews with 17 older people, to explore their experiences of living in a care home, during the four- to six-week period following the move. Purposive sampling was initially adopted, thereafter, theoretical sampling was employed to recruit individuals identified by care managers within older peoples’ community teams and care home managers within a large Health and Social Care Trust in the United Kingdom. Consistent with grounded theory methodology, data collection and analysis occurred simultaneously. Constant comparative analysis underpinned data analysis and data management techniques. Data analysis revealed five distinct categories that captured these experiences. These were: (a) wanting to connect – ‘I am so lost here’, (b) wanting to adapt – ‘Well mentally you have to make the best of it’, (c) waiting for assistance – ‘it's a frustration for me’, (d) ‘waiting on the end’ – I am making no plans’ and (e) wanting to re-establish links with family and home – ‘I love getting home and I like getting out to the town’. Together these five categories formed the basis of the core category, ‘Waiting and Wanting’, which encapsulates the initial adaptation experiences of the men and women in the study. Findings indicate that individuals were dependent on others to create a sense of belonging, independence and wellbeing. Moreover, risk aversive practices were perceived as a threat to individuals’ independence and autonomy. Recommendations include the need to amend policy and practice for the development of a bespoke induction programme for each resident facilitated by a senior member of the care home staff working in partnership with individuals and families, in addition to the health and social care team, to support a more positive transition for new residents, relatives and care home staff.
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Gharibian Adra M, Aharonian Z, Sibai AM. Exploring resident-staff relationships in nursing homes in Lebanon. Int J Qual Stud Health Well-being 2019; 14:1688605. [PMID: 31713467 PMCID: PMC6853206 DOI: 10.1080/17482631.2019.1688605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: To explore the prevailing relationships between residents and staff in nursing homes in Lebanon, and to elicit factors that influence these relationships. Method: Using a qualitative phenomenological design, this study was conducted to explore the lived experience of residents, especially pertaining to their relationships with staff. The study included 13 residents aged 65 and above with no cognitive impairment. Data were collected using semi-structured interviews and were analysed using the Giorgi method. Findings: Two main themes representing resident perceptions about their interactions with the nurses emerged: (1) relationships to satisfy the need for physical care, (2) relationships that foster a bond of caring and trust. Discussion: Reflecting about resident-nurse relationships and examining factors that promote trust and stronger bonding help caregivers understand the importance of fostering a stronger relationship with residents. These findings have implications for developing policy and practice in nursing homes in Lebanon and elsewhere. Conclusion: This is the first study conducted by a nurse researcher in Lebanon that has explicitly explored the nature of relationships between caregivers and care-receivers in nursing homes. The contribution of this study is not solely restricted to experiences and outcomes of care, but also includes implications for policy and practice.
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Affiliation(s)
- Marina Gharibian Adra
- Rafic Hariri School of Nursing, Faculty of Nursing, American University of Beirut, Riad al Solh, Beirut, Lebanon
| | - Zepur Aharonian
- Rafic Hariri School of Nursing, Faculty of Nursing, American University of Beirut, Beirut, Lebanon
| | - Abla Mehio Sibai
- Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Support Needs and Expectations of People Living with Dementia and Their Informal Carers in Everyday Life: A European Study. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8070203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of this study was to describe the needs and expectations of support within everyday life among community-dwelling people living well with an early stage dementia and their informal carers. The study employed a qualitative design. Data were collected in 2018, via four focus group interviews with, in total, 17 people with dementia and 21 informal carers, transcribed and analyzed with manifest content analysis. Needs and expectations of support among persons with dementia were expressed as the importance of “Participation in my own care,” “Attitude of the informal carers,” and “Trusting relationships with informal carers.” Informal carers’ needs and expectations of support were expressed as the importance of “Formal care and services,” “Getting out of a carer mindset,” and “Family context.” The findings from this study highlighted that persons with dementia were well aware of their cognitive impairments and tried to maintain their independence, with both formal and informal care to help remain “being themselves.” Health professionals should acknowledge persons with dementia and informal carers’ well-being, and acknowledge the importance of their needs together with an understanding of the importance of continuity of frontline carers to building trusting relationships.
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