"You're at their mercy": Older peoples' experiences of moving from home to a care home: A grounded theory study

Psychological interventions designed to reduce relocation stress for older people transitioning into permanent residential aged care: a systematic scoping review

OBJECTIVES

This study aimed to identify and evaluate psychological interventions or strategies designed to reduce relocation stress in older people making the permanent transition into residential aged care.

METHOD

A scoping review following the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was conducted. An electronic search of nine databases and the search engine google scholar was completed in December 2022. Article screening and quality appraisal was undertaken independently by at least two reviewers.

RESULTS

Eight full-text articles were included for review, from which four psychological interventions were identified: 1) Resident peer support; 2) Life review; 3) Mental Health Service for Older Adults; 4) The Program to Enhance Adjustment to Residential Living. No interventions were implemented before transitioning into care; all were implemented within three months of resident relocation into an aged care facility.

CONCLUSION

The transition to residential aged care is an inherently distressing experience. The absence of interventions implemented during the pre- and mid-transition phases presents a gap in the literature and suggests an opportunity for early intervention. As population ageing continues to increase, there is a pressing need for the development and implementation of interventions aimed at reducing symptoms of depression and anxiety for older people undertaking this major life transition.

'It's where I belong': what does it mean to age in place from the perspective of people aged 80 and above? A longitudinal qualitative study (wave one)

BACKGROUND

Most people want to remain at home as they age. Ageing in place - remaining at home and connected to the community - is a national and international policy priority; however, to better understand how policy might be implemented, a more nuanced understanding is required about older adults' lived experiences of ageing in place, especially the experiences of those aged 80 and above.

OBJECTIVE

To describe and explore the social processes which enable ageing in place from the perspective of community-dwelling older people (80+).

METHODS

Forty-six respondents (80-100+ years) participated in the first wave of a longitudinal qualitative study set in North East England. Semi-structured interviews were conducted in participants' homes between June 2022 and January 2023. Interviews were analysed using reflexive thematic analysis.

RESULTS

Participants positioned their homes as a place of freedom and as the antithesis of a 'care home'. Remaining in place was important for all participants; a key priority for them was to remain physically active to enable this. However, many participants faced significant hurdles to remaining in place. These were primarily related to health and mobility issues. Some participants were able to overcome such barriers by drawing on financial resources and available social networks.

CONCLUSION

The home is central to understanding older peoples' (80+) experiences of ageing. In a socio-political context which promotes ageing in place, the social factors shaping experiences of ageing in place must be considered. This involves attending to the challenges of later life, particularly health and especially mobility and physical function. Currently, those with resources (social and economic) are better equipped to respond to such challenges, thus potentially exacerbating widening inequalities in ageing. By foregrounding the perspectives of those ageing in place alongside social factors shaping their experiences, our study has important implications for policy and health and social care. We show that a more equitable allocation of resources is vital to fulfil the ageing in place policy agenda. Furthermore, we highlight a need to recognise commitments to ageing in place displayed by people aged 80 and above, especially when remaining in place becomes difficult to achieve.

"Like another human being in the room": a community case study of smart speakers to reduce loneliness in the oldest-old

This community case study examined the potential benefits of smart speakers to tackle loneliness in the oldest old adults living in supported accommodation. The program was established as a collaboration between the supported accommodation provider and a technology company to explore the feasibility of smart speakers to alleviate resident loneliness. Loneliness in later life often accompanies a shrinking social circle, loss of a spouse or increased disability. People aged 85 years of age and over are increasingly likely to experience these life events, leading to an increased risk of social isolation and loneliness. Five older people, mean age 90 years of age, who resided in supported accommodation, were given a smart speaker for 8 weeks to examine their experience with the voice assistant. The experiences of the five older adults are explored as case studies, with each person interviewed both before and after receiving the smart speaker. All five valued their smart speaker, recognised its potential for tackling loneliness, and wanted to keep it. The three most lonely individuals reported that their smart speaker made them feel less lonely and isolated through two mechanisms: (i) creating a presence and (ii) having some control over their situation. Although only a small study, these experiences suggest providing smart speakers for lonely and isolated oldest-old people, could be one way to help combat loneliness in community settings.

Setting up a journal club for healthcare professionals in an older people's residential care setting

With the rise in the number of older people in the population and new developments in older people's services such as integrated care hubs, there is a need for healthcare professionals working with older people to keep up to date with the latest research. This article describes the process of establishing a multidisciplinary journal club in a residential care setting and recognising the potential of such clubs to develop staff members' critical thinking, presentation and communication skills. The authors emphasise the importance of fostering a culture of learning in older people's services and describe how a journal club can support healthcare professionals to maintain their knowledge and improve care.

Transitional care decision-making through the eyes of older people and informal caregivers: An in-depth interview-based study

BACKGROUND

Older people with multifaceted care needs often require treatment and complex care across different settings. However, transitional care is often inadequately managed, and older people and their informal caregivers are not always sufficiently heard and/or supported in transitional care decision-making.

OBJECTIVE

To explore older people's and informal caregivers' experiences with, views on, and needs concerning empowerment in transitional care decision-making.

METHODS

A qualitative descriptive study was conducted in the TRANS-SENIOR consortium's collaborative research using semistructured in-depth interviews between October 2020 and June 2021 in Flanders, Belgium. A total of 29 people were interviewed, including 14 older people and 15 informal caregivers who faced a transition from home to another care setting or vice versa. Data were analysed according to the Qualitative Analysis Guide of Leuven.

FINDINGS

Five themes were identified in relation to the participant's experiences, views and needs: involvement in the decision-making process; informal caregivers' burden of responsibility; the importance of information and support; reflections on the decision and influencing factors.

CONCLUSIONS

Overall, older people and informal caregivers wished to be more seen, recognised, informed and proactively supported in transitional care decision-making. However, their preferences for greater involvement in decision-making vary and are affected by several factors that are both intrinsic and extrinsic. Therefore, healthcare systems might seek out age-tuned and person-centred empowerment approaches focusing on older people's and informal caregivers' empowerment. For future studies, we recommend developing specific strategies for such empowerment.

PATIENT OR PUBLIC CONTRIBUTION

Older persons' representatives were involved in designing the TRANS-SENIOR programme of research, including the current study. Healthcare professionals and nursing care directors were involved in the study design and the selection and recruitment of participants.

Shared decision-making with adults transitioning to long-term care: A scoping review

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.

Loss, Unresolved Trauma and Gaps in Staff Knowledge: A Qualitative Study on Older Adults Living in Residential Aged Care

Despite the prevalence of mental health concerns among those who live in residential aged care, many residential aged care facilities (RACFs) provide little by way of psychological support. Drawing on qualitative data obtained from interviews with residents from across 15 RACFs in Victoria, Australia, this article adds to understandings about the diversity and impact of mental health challenges experienced by residents, and gaps in the knowledge of staff about how to address such. Thus, it also offers evidence of the urgent need for RACFs to provide residents both better access to specialist mental health practitioners and training to care staff on mental health issues.

'The Primacy of 'Home': An exploration of how older adults' transition to life in a care home towards the end of the first year

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.

Environment in institutional care settings as a promoting factor for older individuals' mobility: A systematic review

Background

Mobility is important for health and well‐being; however, older individuals in institutional care settings are relatively sedentary. The environment has an increased influence on mobility in older age due to changes in individual functioning; thus, environmental mobility support solutions for this population are needed.

Objectives

The aim of this systematic review was to identify elements of the environment that have been used in the content and delivery of interventions to promote mobility and to assess the effects of these interventions on mobility outcomes.

Design

A systematic literature search was conducted using CINAHL and MEDLINE from the earliest date through 30 September 2020 for randomised controlled trials, quasi‐experimental and pre‐post design studies. Inclusion and critical appraisal of articles were conducted by two independent researchers. Data were extracted and synthesised.

Setting and participants

Studies were included if they had employed some element of the environment in the content and/or delivery of the intervention and had assessed mobility‐related outcomes of older individuals in institutional long‐term care settings providing full‐time care.

Measures

Studies were included if they reported data on mobility‐related outcomes including aspects of physical activity, physical function, life space and functional autonomy.

Results

Eight studies were included. Physical, social and symbolic elements of the environment were utilised in the interventions. Positive effects on mobility outcomes were reported in exercise interventions utilising environmental elements mostly as supportive components.

Conclusions and implications

Empirical evidence about effective mobility interventions employing elements of the environment as main intervention components is lacking. A serious dilemma exists about the need for older individuals’ independence and mobile/active late life and the lack of support for such initiatives in long‐term care. Given the emphasised relationship of the environment and mobility with age due to changes in functioning, environmental solutions require further examination.

Healthcare Professionals' Perceptions of Loneliness amongst Older Adults: A Qualitative Study

BACKGROUND

Loneliness amongst older adults is linked to poor health outcomes and constitutes a public health issue worldwide. Healthcare professionals' perceptions could influence the strategies they implement in order to prevent, detect and manage loneliness amongst older adults. The aim of this study was to describe and understand healthcare professionals' perceptions of loneliness amongst older adults.

METHODS

A descriptive qualitative study. Twenty-six Spanish healthcare professionals with experience caring for older adults participated in the study. Data were collected between November 2019 and September 2020 using focus groups and in-depth interviews. Data were analysed following a content analysis method using ATLAS.ti software.

RESULTS

Healthcare professionals' perceptions of loneliness amongst older adults is represented by three themes: (1) "when one's personal life and social context lead to loneliness"; (2) "from abandonment to personal growth: the two faces of loneliness"; and (3) "loneliness as a health issue that needs to be addressed".

CONCLUSIONS

Healthcare professionals perceive loneliness as a multifactorial, subjective experience that can trigger different coping mechanisms and negatively affect older people's health. Healthcare professionals consider that a greater involvement of the whole society is needed in order to fight loneliness amongst older adults as a public health issue.

Making meaning of the new identity-as-resident: A grounded theory study

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.

‘Knowing me, knowing you’: an exploration of the views and experiences of nursing home residents and staff on their nursing home as ‘home’

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.

‘Waiting and Wanting’: older peoples’ initial experiences of adapting to life in a care home: a grounded theory study

A 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.