Why older persons seek nursing care: towards a conceptual model

What do nursing home residents with mental-physical multimorbidity need and who actually knows this? A cross-sectional cohort study

OBJECTIVE

Aging societies will bring an increase in the number of long-term care residents with mental-physical multimorbidity. To optimize care for these residents, it is important to study their care needs, since unmet needs lower quality of life. To date, knowledge about care needs of residents with mental-physical multimorbidity is limited. The aim of this study was to explore (un)met care needs of residents with mental-physical multimorbidity and determinants of unmet needs.

METHODS

Cross-sectional cohort study among 141 residents with mental-physical multimorbidity without dementia living in 17 geronto-psychiatric nursing home units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. The Camberwell Assessment of Need for the Elderly (CANE) was used to rate (un)met care needs from residents' and nursing staff's perceptions. Descriptive and multivariate regression analyses were conducted.

RESULTS

Residents reported a mean number of 11.89 needs (SD 2.88) of which 24.2% (n = 2.88, SD 2.48) were unmet. Nursing staff indicated a mean number of 14.73 needs (SD 2.32) of which 10.8% (n = 1.59, SD 1.61) were unmet. According to the residents, most unmet needs were found in the social domain as opposed to the psychological domain as reported by the nursing staff. Different opinions between resident and nursing staff about unmet needs was most common in the areas accommodation, company, and daytime activities. Further, nearly half of the residents indicated 'no need' regarding behavior while the nursing staff supposed that the resident did require some kind of support. Depression, anxiety and less care dependency were the most important determinants of unmet needs.

CONCLUSIONS

Systematic assessment of care needs showed differences between the perspectives of resident and nursing staff. These should be the starting point of a dialogue between them about needs, wishes and expectations regarding care. This dialogue can subsequently lead to the most optimal individually tailored care plan. To achieve this, nurses with effective communication and negotiation skills, are indispensable.

A qualitative study of older people with minimal care needs experiences of their admission to a nursing home with Registered Nurse care

Purpose

– Residential care for older people in the UK includes care homes with and without 24-hour Registered Nurse (RN) care. Reduced autonomy and personal wealth can result when people assessed as having minimal care needs, enter and reside in care homes with RN care. The purpose of this paper is to explore the experiences of older people with minimal care needs admission to care homes with RN care.

Design/methodology/approach

– A qualitative study using a grounded theory method was undertaken. In total, 12 care home with RN care residents assessed as not requiring nursing care were interviewed. Initial sampling was purposive and progressed to theoretical. Interviews were analysed using the grounded theory analysis method of constant comparison and theory development.

Findings

– Two main categories emerged: “choosing the path”, which concerned the decision to enter the home, and “settling in”, which related to adaptation to the environment. Findings suggested participants who perceived they had greater control over the decision-making process found it easier to settle in the care home. The two categories linked to form an emerging framework of “crossing the bridge” from independent living to care home resident.

Research limitations/implications

– The findings contribute to the understanding of factors influencing admission of older people with minimal care needs to care homes with RN care and highlight the importance of informed decision making.

Practical implications

– Health and social care professionals must give informed support and advice to older people seeking care options to ensure their needs are best met.

Originality/value

– This study enabled older people with minimal care needs admission to care homes with RN care to voice their experiences.

Older people and barriers to self-reporting of chronic pain

Too many older adults live with the negative consequences of chronic pain and its detrimental impact on quality of life. To explore this, an extended literature review was conducted to identify barriers the older person encountered in the self-reporting of their chronic pain. Four themes were found to mediate help-seeking behaviour. Attitudes such as stoicism, beliefs such as pain being a necessary part of ageing, and the external barriers generated by health professionals, all have a multidimensional relationship with the 'decision' to seek help for pain. Personality and the perceived importance of independence were found to influence these responses. The findings imply that communication between the health professional and patient needs to improve during the more comprehensive assessment of chronic pain. To achieve such improvements, it is first necessary to eradicate ageist attitudes held both by the elderly and within health care.

Attitudes of older Egyptians towards nursing care at home: a qualitative study

The aim of this study was to identify the attitudes of older Egyptians towards receiving nursing care at home and to identify the characteristics that allow differentiating between various types of these attitudes. The number of older persons in Egypt requiring nursing care is increasing. Care was traditionally provided by the family, but the social network is changing in bigger cities. Beside geriatric homes, older Egyptians can refer to private helpers and a small number of home care services. Structured guideline interviews were performed with 33 Egyptians above 60 years of age. Participants were chosen by purposeful sampling. Twelve of them received home care. Interviews were analyzed with qualitative content analysis according to Mayring. Participants could be classified under three main categories of care seeking types: (1) insufficient income, (2) sufficient income and family dependent decision about care, (3) sufficient income and independent decision about care. Variations under these categories were due to differences in the social network and the perceived self-help abilities. Examples for the influence of factors which explained variations were not identified in every category to the same extent. Some types of care seeking that exist in reality may be missing in this study. Findings suggest the hypothesis that care seeking of older Egyptians is related to their social status. Those with insufficient income seem to reject home care whereas independent personalities with sufficient income may be the main winners of this offer.