Aged care residents' prioritization of care: A mixed-methods study

Community Preferences for Allied Health Services in Residential Aged Care

INTRODUCTION

Exploring health consumer preferences in care is an essential foundational, and ongoing activity, when designing and delivering models of care. We undertook a study to explore: (i) what allied health (AH) services are most important to health consumers and (ii) how health consumers expect to access these services in residential aged care (RAC) to determine consumer priorities in future AH models of care in RAC.

METHODS

A mixed method study was conducted with aged care residents and community members (friends or family of residents/people who believe they may use RAC services). The study comprised two focus-group activities where participants were asked to (1) rank the AH services most important to them and then (2) categorise how they would prefer to access each AH service. Focus group members used card sort methods (Q-methodology) to aid prioritisation, categorisation and discussion. Card sorting data were analysed using inverted factor analysis and descriptive statistics. Qualitative focus group data were deductively coded using a coding structure created by the research team informed by quantitative results.

RESULTS

Data were collected from 16 participants who formed five focus groups in a community forum. The analysis revealed three factors, that represented shared meaning amongst groups of participants (viewpoints) regarding prioritisation of AH services: 'Prioritising urgent needs', 'Prioritising long-term healthy habits and lifestyle', and 'Prioritising social well-being'. Data from the card sort activity, which related to 'how health consumers expect to access AH services', were also categorised into three categories: 'It is always provided', 'A professional will assess my need' and 'I or my family will ask for this service if I need it'. Participants wanted most AH services to be provided regularly, with some such as 'Exercise and rehabilitation' and 'Meaningful activity' to be provided up to one hour every day.

CONCLUSION

Consumers value a range of AH services and have an expectation that these will be provided in RAC on a regular basis. To ensure consumers make informed preferences regarding the future of services in RAC, health systems need to trial innovative AH models of care and embed consumer evaluation.

Caregiving in long-term care before and during the COVID-19 pandemic: a scoping review

PURPOSE

The COVID-19 pandemic magnified pre-existing socioeconomic, operational, and structural challenges in long-term care across the world. In Canada, the long-term care sector's dependence on caregivers as a supplement to care workers became apparent once restrictive visitation policies were employed. We conducted a scoping review to better understand the associations between caregiving and resident, formal and informal caregiver health in long-term care before and during the COVID-19 pandemic.

METHODS

A literature search was performed using MEDLINE, AgeLine, Google Advanced, ArXiv, PROSPERO, and OSF. Pairs of independent reviewers screened titles and abstracts followed by a review of full texts. Studies were included if they reported biological, psychological, or social health outcomes associated with caregiving (or lack thereof).

RESULTS

After screening and reviewing 252 records identified by the search strategy, a total of 20 full-text records were eligible and included in this review. According to our results, research on caregiving increased during the pandemic, and researchers noted restrictive visitation policies had an adverse impact on health outcomes for residents and formal and informal caregivers. In comparison, caregiving in long-term care prior to the pandemic, and once visitation policies became less restrictive, led to mostly beneficial health outcomes.

CONCLUSION

Caregiver interventions, for the most part, appear to promote better health outcomes for long-term care residents and formal and informal caregivers. Suggestions to better support caregiving in long-term care settings are offered.

Seeking residents' views regarding Australian residential aged care: A scoping review

OBJECTIVE

This scoping review aimed to explore topics on which the views of residents of Australian residential aged care facilities (RACFs) have been sought.

METHODS

Scoping review methodology as outlined by Arksey and O'Malley was used to identify, explore and report on the range of literature regarding views of RACF residents. Seven electronic databases were searched using broad search terms relevant to the RACF context. Descriptive numerical analysis was completed for publication year, journal name and target profession, research methods and participant types. Thematic analysis then focussed on the aims of the included studies.

RESULTS

Four thousand two hundred and ninety studies were screened, and 104 publications met the inclusion criteria. A broad range of topics were explored by researchers, with the largest number of papers focused on residents' views of systems within RACFs (n = 24) and new programs and interventions (n = 21). Smaller topic areas included health conditions and health-care services (n = 13), socialisation (n = 13), physical activity (n = 3), self-care (n = 4), leisure (n = 4), general everyday life (n = 20) and aspects of the residential aged care environment (n = 15). There was limited exploration of meaningful activity (n = 13). The inclusion of residents with cognitive impairment was inconsistent, and the voices of other stakeholders were often privileged.

CONCLUSIONS

Voices of residents must be heard in order to prioritise the health and well-being of this population. More research which focuses on what is important to residents is needed and must include residents with cognitive impairment more effectively. Identification of optimal research methods with this population would make an important contribution in this area.

Health communication and shared decision-making between nurses and older adults in community setting: An integrative review

AIM

To explore the role of health communication in Shared Decision-Making (SDM) between nursing staff and older people in the community setting.

BACKGROUND

Society and healthcare services are marked by an exponentially ageing population, leading to a significant proportion of patients being older adults with highly demanding care needs. Scientific literature supports shared decision-making as a process that engages patients in their care. However, the increasing use of technology and the consequences of the COVID-19 pandemic have influenced how nurses communicate with older patients. Therefore, it is crucial to understand how to develop health communication to reach effective, shared decision-making processes.

METHODS

Whittemore and Knafl's integrative review method, the literature search comprised five databases: PubMed, CINALH, Web of Science, Scopus and PsycINFO.

RESULTS

The 12 included studies were synthesised into three study patterns: (1) nurse-older patient health communication relationship, (2) older patients' perspectives and (3) nontherapeutic communication in end-of-life care.

CONCLUSION

This review underscored the crucial role of effective health communication in shaping SDM dynamics between nursing staff and older people in the community setting. Key elements included transparent information exchange, establishing trust and maintaining communication channels with informal caregiving networks. SDM actions were aligned with preserving older people's autonomy, but communication challenges persisted, particularly in end-of-life situations. Advanced care planning was recommended to address these shortcomings and improve communication among older people, healthcare professionals and families.

IMPLICATIONS

Implementing educational measures based on verbal and nonverbal health communication in nursing training could be beneficial. Nursing research could continue to develop and refine specific communication strategies adapted to the social determinants of health for diverse clinical situations regarding older adults in the community setting.

REPORTING METHOD

The authors have adhered to relevant EQUATOR guidelines through the PRISMA 2020 checklist. No Patient or Public Contribution.

Confirmatory Factor Analysis of the Spirituality and Spiritual Care Rating Scale: A Cross-Sectional Study in Eight US Nursing Homes

The aim of this study was to test a modified Spirituality and Spiritual Care Rating Scale (SSCRS) and report initial findings, based on a cross-sectional descriptive survey from eight nursing homes in the USA. This study examined the psychometric properties of a modified version of the SSCRS for assessing the perceptions of staff (i.e. nurses, rehabilitation staff, food and nutrition service staff, activities staff, social workers, and administrative staff) who work in nursing homes. The modified version of the SSCRS is measuring respondents' perceptions of spirituality, spiritual care, religiosity, and personalized care. Confirmatory factor analysis showed satisfactory goodness of fit for the original four-factor structure of the SSCRS. The modified version demonstrated good internal consistency and reliability (Cronbach's alpha ranging from 0.71 to 0.90). Initial findings showed statistically significant differences across all four sub-scales. Further research is needed to psychometrically test the modified tool.

What about the fundamentals of nursing-its interventions and its continuity among older people in need of home- or facility-based care: a scoping review

AIM

This scoping review investigated and descriptively summarised previous research about fundamental nursing, its focus (what care needs are described, how is it described and by whom is it described), continuity of care (is it described in relation to fundamental nursing) and possible nursing interventions or activities targeting older people's fundamentals of care needs in home- or facility-based care.

METHODS

This scoping review was carried out following the steps of Arksey and O'Malley's methodology and PRISMA-ScR reporting guidelines. Searches were conducted in PubMed via NIH, CINAHL via EBSCO and PsycInfo via ProQuest for the time period between January 2002 and May 2023.

RESULTS

Forty-two studies were included where the majority had been conducted in a facility-based care context. Nutrition-or rather nutritional care activities targeting eating and drinking-was the most frequently described fundamental care needs addressed. After this came personal care such as cleansing, dressing, oral care, skin, and foot care. Few studies addressed more than one fundamental care need at the time. The nursing staff described fundamental nursing as complex, comprehensive, and demanding. Older people and relatives described a gap between the fundamental nursing provided and their perceived need for support. Less attention was given to older peoples relational and psychosocial needs. Identified nursing interventions mainly targeted physical care needs. Our findings also implied that interventions focusing on fundamental nursing were described as feasible in practice with favourable or moderate results, while long-term effects were difficult to detect. No studies were identified focusing on fundamental nursing in relation to outcomes such as continuity of care.

CONCLUSION

Fundamental nursing was mainly described in relation to physical care needs, which were essentially conducted within facility-based care contexts. Interventions and activities primarily focused on one fundamental need at the time, mainly within the physical domain. No nursing interventions were identified focusing on relational and psychosocial needs where continuity of care can be viewed as a relevant outcome. Such limited focus are especially concerning as research has highlighted the importance of that older people with complex care needs can benefit from a holistic and person-centred approach i.e. fundamental nursing.

TRIAL REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/XJ39E Protocol: http://dx.doi.org/10.1136/bmjopen-2022-069798.

Older peoples' lived experiences of personalised care in care homes: A meta-ethnography

BACKGROUND

Guidance and policy on personalised (or person-centred) care of older people living in care homes advocates that all residents must have their preferences considered, and that all care provided must be reasonably adjusted to meet the person's specific needs. Despite this, research that considers what matters to residents in terms of the care they receive is limited.

OBJECTIVES

Our review aims to explore care home residents' lived experiences of personalised care and understand what really matters to them.

METHODS

Six electronic databases (CINHAL, Medline (Ovid), Embase, PubMed, Web of Science & PsychInfo) and Google Scholar (grey literature) were searched to identify qualitative studies relating to personalised care in care home settings, which also included resident (voices) quotes. The literature review and synthesis are reported using eMERGe guidance.

RESULTS

Fifteen studies met the inclusion criteria for our meta-ethnography. Four conceptual categories (the challenge of fitting into institutional care, the passing of time, holding onto a sense of self and a desire to feel at home) and two key concepts (creating a culture of purposeful living and caring and forming and maintaining meaningful & empowering relationships) were identified. Finally, a conceptual framework of understanding represents what personally matters to residents in terms of their care.

CONCLUSION

Our meta-ethnography, guided by residents' lived experiences of personalised care, offers a new perspective of what personally matters to residents in terms of the care they receive. The conceptual framework of understanding highlights the importance of moving from an institutional position of doing for residents to a person-centred position of doing with residents.

IMPLICATIONS FOR PRACTICE

Our findings highlight the importance of understanding the differences between personalised and person-centred care for policy and practice. Further considerations are required on how this might be applied through nurse and care home professionals' education and work practices.

Registered nurses' perceptions and experience of working in aged care: A qualitative approach

AIM

To understand and report on the perceptions and experiences of registered nurses in the aged care sector.

DESIGN

An exploratory qualitative study.

METHODS

Semi-structured telephone interviews were utilised as the primary data collection method. Fifteen registered nurses were interviewed. All interviews were recorded, transcribed verbatim and analysed using conventional content analysis. Participants were quoted verbatim to ensure authenticity.

RESULTS

The results indicated a demand for increased administrative and staffing support in the aged care workplace. Poor morale and unethical practices contributed to negative perceptions and attitudes among nurses towards aged care. Managing and communicating with older people was reported as challenging, which impacts nursing staff recruitment and retention. Future work is needed to ensure that outstanding clinical role models and leadership support nursing staff recruitment and retention. Incorporating aged care content into the nursing curriculum and providing professional development opportunities to aged care professionals would be the foundation towards solutions, as the study primarily explored nurses' perspectives.

Public Mixed Funding for Residential Aged Care Facilities Residents' Needs in the Asia-Pacific Region: A Scoping Review

Due to population aging and sociodemographic change, there is an increasing reliance on residential aged care facilities in the Asia-Pacific region. Most countries have adopted taxation as the primary means to levy capital for funding universal health services and means-testing of benefits may be further incorporated as a policy balance between horizontal equity and fiscal sustainability. It was hypothesized that residential care needs are evaluated by assessments relating to funding; this scoping review seeks to synthesize how such assessments relate to the care needs of residents. Searches were conducted in concordance with a priori protocol for English-language literature published since 2008 in Embase, CINAHL, PubMed, Scopus, JBI, TROVE, and four peak international organizations for studies and reports that describe the assessment of residents' needs in Asia-Pacific countries that used a mixture of taxation and means-testing to publicly fund residential aged care. One paper and 47 reports were included. Australia, New Zealand, and Singapore utilize a taxation and means-tested user charge approach to fund residential aged care needs. The common care needs assessed include health conditions, daily activities, cognition, psychiatric, and behavioral needs. While essential care needs are publicly funded, other holistic care needs, such as spirituality and autonomy-based needs, still need to be covered for meaningful occupation by the residents.

Emotional Impact and Perception of Support in Nursing Home Residents during the COVID-19 Lockdown: A Qualitative Study

Social isolation measures implemented in nursing homes during the COVID-19 pandemic generated occupational imbalance, discomfort, and mental health impairment in residents. We aimed to analyze the lived experience of elderly nursing home residents during the lockdown and social contact restrictions resulting from the COVID-19 pandemic.

METHODS

Exploratory qualitative study. Information was collected through in-depth interviews and field notes. An inductive thematic analysis was performed and international recommendations for the development of qualitative studies were followed.

RESULTS

Twenty-four participants residing in nursing homes were included. Two main themes were identified: (1) emotional impact of the experience of COVID-19 lockdown (subthemes: experience of contradictory feelings; illness and death; importance of routine; feeling busy; and role of religious beliefs); and (2) support as a therapeutic tool (subthemes: family support; peer support; and professional support).

CONCLUSION

Social restrictions by COVID-19 caused significant changes in residents' occupations and routines, producing fear, loneliness, and abandonment of desired occupations; however, very important supports were also identified that helped to overcome the lockdown, such as social support, spirituality, and gratitude.

Funding systems for care needs of older adults in residential aged care facilities in the Asia-Pacific region: a scoping review protocol

OBJECTIVE

The objective of this review is to explore the care needs as assessed by the public residential aged care funding systems of Asia-Pacific countries that use both taxation and means-tested user charge.

INTRODUCTION

The Asia-Pacific region is at the forefront of population aging. There is increasing reliance on residential aged care facilities to provide formal care, but limited understanding of how care needs are assessed. Most countries have adopted taxation as the primary means to levy capital for funding essential health services; funding may be means-tested for equity.

INCLUSION CRITERIA

The population of interest is older adults eligible for care in residential aged care facilities who receive assistance to fund their care. Sources that address the care needs of residents and the assessments relating to care needs, as well as funding systems (taxation, means-testing), will be considered for inclusion. This review will consider any quantitative study, qualitative study, mixed method study, or report from any country in the Asia-Pacific region.

METHODS

Databases to be searched include Embase, CINAHL, PubMed, Scopus, and the JBI Database for Evidence-based Practice. Additional records will be identified through the gray literature database Trove, reference lists of included studies, and relevant health organization websites. Sources published in English since 2008 will be eligible for inclusion. Two reviewers will independently screen titles, abstracts, and full-texts for inclusion. Data will be extracted and findings summarized in tabular format and narrative synthesis. Any disagreements between the reviewers will be resolved through discussion or with a third reviewer.

SCOPING REVIEW REGISTRATION

Open Science Framework; https://osf.io/h9g7q.

Health, well-being and quality of life in aged care: Validation of theoretical domains to inform a person-centred outcomes measurement framework

OBJECTIVES

The constructs of health, well-being and quality of life are not routinely understood or measured for people accessing aged care services. This study aimed to identify and validate theoretical domains of health, well-being and quality of life for recipients of care, their informal carers and staff, and inform the development of a person-centred outcomes measurement framework.

METHODS

First, a rapid review to identify recurrent domains of health, well-being and quality-of-life in aged care, using systematic searches of electronic databases, and review of grey literature, following the PRISMA guidelines. Second, establish content validity of identified domains using (a) Delphi technique with n = 134 aged care staff, care recipients and caregivers, and (b) comparability with categories within the International Classification of Functioning, Disability and Health (ICF) and ICF Geriatric Core Set.

RESULTS

From 972 records detected in the rapid review, 19 peer-reviewed research articles and 27 grey literature sources were included in the content analysis. Twenty-four domains and 109 concepts were identified, and health, quality of life, security and food and nutrition were ranked as the most important. One domain, cognition, linked to both the Geriatric Core Set and ICF, and 37% of domains and 39% of concepts were evident within the ICF.

CONCLUSIONS

This study identified and validated 24 important domains of health, well-being and quality of life for the older person receiving care, their informal carers and staff. These domains can be used to guide the selection of outcome measures and facilitate person-centred care and care planning.

Rushing Care by Care Aides Associated With Experiences of Responsive Behaviors From Residents in Nursing Homes

OBJECTIVES

Residents with cognitive impairment favor "slow care," so rushed care may cause additional responsive behaviors (eg, verbal threats, hitting) among residents. We assessed the association of rushed care (physical and social) by care aides with their experiences of responsive behaviors from residents.

DESIGN

Cross-sectional analysis of survey data.

SETTING AND PARTICIPANTS

A total of 3547 care aides (response rate: 69.97%) in 282 care units in a stratified random sample (health region, nursing home size, owner-operator model) of 87 urban nursing homes in Western Canada.

METHODS

Data collection occurred between September 2019 and February 2020. The dependent variables were care aide self-report of 4 types of verbal and physical responsive behavior (yes/no). The independent variables were care aide self-report of rushed physical care (count, range = 0-6) and rushed social care (yes/no). We conducted a 2-level random-intercept logistic regression with each dependent variable, controlling for care aide, care unit, and nursing home characteristics.

RESULTS

In their most recent shift, 2182 (61.5%) care aides reported having rushed at least 1 physical care task and 1782 (50.2%) reported having rushed talking with residents (social care task). When care aides rushed an additional physical care task, they had 8% higher odds of reporting having experienced yelling and screaming [odds ratio (OR) 1.08, 95% CI 1.01-1.15; P = .019]. When care aides rushed social care (talking with residents), they had 70% higher odds of reporting having experienced yelling and screaming (OR 1.70, 95% CI 1.28-2.25; P < .001). We observed the same pattern for the other types of responsive behaviors.

CONCLUSIONS AND IMPLICATIONS

Rushing of physical or social care tasks by care aides was associated with increased likelihood of responsive behaviors from residents. One approach to reducing both rushed care and resident responsive behaviors may be to improve the care environment for care aides and residents.

Aged care residents' prioritization of care: A mixed-methods study

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.