The feasibility of measuring social networks among older adults in assisted living and dementia special care units

Objectively Measured Physical Activity and Sedentary Behaviors Among Older Adults in Assisted Living Facilities: A Scoping Review

Older adults in assisted living facilities (ALF) are at risk for low physical activity (PA) and high sedentary behavior (SB), both of which place them at risk for negative health outcomes. The purpose of this scoping review was to synthesize evidence describing the volume of device-measured PA/SB, factors associated with PA/SB, and interventions designed to change PA/SB in older adults living in ALF. Twenty articles representing 15 unique studies were identified from eight electronic databases and grey literature. Residents in ALF spent 96-201 min/day in light PA (n = 2 studies), 1-9.74 min/day in moderate to vigorous PA (n = 2 studies), and 8.5-11.01 hr/day of SB during waking hours (n = 3 studies). Factors associated with PA included 16 personal factors (n = 6 articles), one social factor (n = 2 articles), and two environmental factors (n = 2 articles). Factors associated with SB included 14 personal factors (n = 4 articles) and one social factor (n = 1 article). No intervention successfully changed PA/SB.

Associations between social networks, cognitive function, and quality of life among older adults in long-term care

BACKGROUND

Having rich social networks is associated with better physical and cognitive health, however older adults entering long-term care may experience an increased risk of social isolation and consequent negative impacts on cognitive function. Our study aimed to identify if there is an association between accessing specific types of services or activities within long-term care on social networks and cognition.

METHODS

A cross-sectional study of 96 residents from 2 aged care providers in New South Wales, Australia. Residents were given a battery of assessments measuring social network structure (Lubben Social Network Scale, LSNS-12), quality of life (EuroQol 5D, Eq. 5D5L) and cognitive function (Montreal Cognitive Assessment, MoCA). Demographic factors and service use factors were also collected from aged care providers' electronic records. Independent sample t-test, ANOVA and linear regression analyses were used to explore associated factors for cognition.

RESULTS

Residents had a mean age of 82.7 ± 9.4 years (median = 81) and 64.6% were women. Most residents had cognitive impairment (70.8%) and reported moderate sized social networks (26.7/60) (Lubben Social Network Scale, LSNS-12). Residents who had larger social networks of both family and friends had significantly better cognitive performance. Service type and frequency of attendance were not associated with cognitive function.

CONCLUSIONS

Among individuals most at risk of social isolation, having supportive and fulfilling social networks was associated with preserved cognitive function. The relationship between service provision and social interactions that offer psychosocial support within long-term facilities and its impact over time on cognitive function requires further exploration.

Promoting meaningful engagement for residents living with dementia through intergenerational programs: a pilot study

OBJECTIVES

Residents living with dementia in residential aged care facilities (RACFs) have reduced access to, and opportunities for, participation in meaningful activities. This leads to increased social isolation and disengagement. Intergenerational programs aim to overcome these issues. Allied health students piloted a live-intergenerational program (LIP), living onsite at a residential aged care facility (RACF) while volunteering for 30 h a month. The purpose of this study was to explore the impact and practicalities for implementing a LIP in an Australian RACF.

METHODS

This qualitative descriptive pilot study was undertaken to explore the diverse perspectives of various stakeholders. Qualitative data were collected during group discussions directed by the nominal group technique with live-in-students. Interviews were conducted with staff members, relatives, facility management and volunteers. All qualitative data were analysed thematically.

RESULTS

Two overarching themes emerged. The first, community of care, indicated how care partners and the care context, organisational support and being a live-in-student supported the sustainability of the program. Live-in-students' accessibility promoted opportunities for occupational and social engagement of residents when staff was less available. The second, a collective based on belonging and shared doing, highlighted the program's potential impact and uncovered the development of a collective based on shared belonging.

CONCLUSION

The LIP highlighted the potential for new dimensions to person-centred care. The pilot study demonstrated intergenerational contact within aged residential care supported the evolvement of a collective and promoted a social approach for ageing well. Further research is needed to identify the long-term impact of the LIP and explore the feasibility of expanding the program.

Social Networks in Retirement and Assisted Living Communities: A Literature Review

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.].

Social Isolation Among Older Adults in Long-Term Care: A Scoping Review

Objectives: A wealth of literature has established risk factors for social isolation among older people; however, much of this research has focused on community-dwelling populations. Relatively little is known about how risk of social isolation is experienced among those living in long-term care (LTC) homes. We conducted a scoping review to identify possible risk factors for social isolation among older adults living in LTC homes. Methods: A systematic search of five online databases retrieved 1535 unique articles. Eight studies met the inclusion criteria. Results: Thematic analyses revealed that possible risk factors exist at three levels: individual (e.g., communication barriers), systems (e.g., location of LTC facility), and structural factors (e.g., discrimination). Discussion: Our review identified several risk factors for social isolation that have been previously documented in literature, in addition to several risks that may be unique to those living in LTC homes. Results highlight several scholarly and practical implications.

Factors Associated with Home Care Outcomes among Community-Dwelling Older Adult Patients with Dementia

Background

With the increase in the proportion of people with dementia (PWD), it is necessary to address dementia-related issues among older adults who live at home; however, there is no integrative review on this issue.

Objectives

To describe and analyze quantitative and qualitative studies from primary sources in order to identify the factors which impact home care outcomes among PWD.

Methods

A computer search of PsycINFO, MEDLINE (PubMed), and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed. This study was guided by Whittemore and Knafl's integrative review method.

Results

This review of the literature identified 3 main factors related to home care outcomes among PWD. These factors are environmental factors, caregiver-related factors, and social network factors.

Conclusions

Further research is required to investigate the impacts of multiple social and environmental factors on home care outcomes among PWD; which can eventually be used by nurses and family caregivers when providing care for older adult PWD.

A review and preview of developments in the measurement of sociability

Sociability is a complex, multifactorial trait. Its importance is underscored by a multitude of negative physical and mental health effects related to loneliness and social isolation. However, current measures of sociability primarily rely on subjective recall and self- report, which have inherent weaknesses and limitations. Although objective and automatic measurements could help to avoid some of these issues, they are still in early stages of development. In this article, the authors review past and present methods of measuring sociability and social interactions. This encompasses both subjective and objective subsets of qualitative and quantitative measurement modalities to gain a broader, more accurate perspective on sociability. Through an analysis of advantages and disadvantages of measurement methods within these categories, a foundational knowledge of sociability measurement can be understood. Utilizing current technology and research methods holds promise to more accurately represent individuals' social networks and social patterns.

Nursing home residents' perspectives on their social relationships

AIMS AND OBJECTIVES

To explore nursing home residents' perspectives on their relationships with other residents, family members and staff.

BACKGROUND

The cultivation of social relationships is central to promoting well-being in nursing homes, as these relationships allow residents, family members and staff to be valued as unique persons and empowered as partners in care. Few studies have examined how nursing home residents perceive the relationships in their social networks, both within and beyond the facility.

DESIGN

Qualitative secondary analysis.

METHODS

We analysed individual and group interviews obtained during "stakeholder engagement sessions" with cognitively intact residents (N = 11 sessions; N = 13 participants) from two nursing homes in North Carolina. The interviews were conducted as part of a larger study on person-directed care planning. We integrated thematic and narrative analytic approaches to guide the analysis of interview data, using a three-cycle coding approach. The COREQ checklist was followed.

RESULTS

Four broad themes emerged from this analysis: (a) peer relationships foster a sense of belonging, purpose, achievement and significance; (b) residents' relationships with family members support a sense of belonging, continuity and significance; (c) mutual respect and reciprocity between residents and nursing home staff promote a sense of belonging and significance; and (d) organisational factors pose barriers to forging meaningful relationships. Each type of relationship-peer, family and staff-made distinctive contributions residents' psychosocial well-being.

CONCLUSION

Recognising the diverse roles of different actors from residents' social networks raises questions for future research to optimise the distinctive contributions of network members that promote residents' psychosocial well-being.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the need for nursing home staff to understand how residents' social relationships influence residents' psychosocial outcomes. Staff training programmes are needed to support residents' rights and to dispel inaccurate interpretations of regulations that threaten sustained meaningful relationships.

Location, location, location: Close ties among older continuing care retirement community residents

This study examines two theoretical explanations for the existence of close ties among continuing care retirement community residents: the attractiveness theory, which suggests that residents who possess certain attributes are more likely to be perceived as appealing to others; and the homophily theory, which argues that individuals are more likely to have close ties with people who share similar attributes. As a variant of the homophily theory, we also examined whether sharing a physical location makes the existence of certain connections more likely. Data from four continuing care retirement communities were used. To test the attractiveness theory, correlations between the number of individuals who named a person as a significant contact (ego's in-degree) and ego attributes were examined. To test the homophily theory, the median value of existing ties was compared against all possible social ties as though they were randomly formed. Finally, to further test the role of the institutional culture against various motivations that drive social ties-attractiveness and homophily-we used link prediction models with random forests. In support of the homophily theory, beyond the institutional culture, the only consistent predictor of the existence of close ties among residents was sharing a wing in the retirement community (geographic proximity). Therefore, we discuss the role of the physical location in the lives of older adults.

Residents' Positive and Negative Relationship Networks in a Nursing Home

Person-centered care involves consideration of long-term care residents' lived experience, including social relationships. The current cross-sectional study investigated co-resident social networks in three units of a 94-bed Australian nursing home, including an 18-bed dementia-specific unit (DSU). Six care staff were interviewed. Chart, self-reported social isolation, and staff-reported social engagement data were collected for 36 residents ages 63 to 94 who consented to full participation. Fifty-five additional residents were included in observations. Median positive-to-negative network size ratios within units were 1.5:1 (Unit 1), 0.7:1 (Unit 3), and 0:1 (DSU). Moderate positive correlations existed between: perceived social support and total positive relationships [ρ(25) = 0.44, p = 0.03]; social withdrawal and total negative relationships [ρ(36) = 0.51, p = 0.002]; and objective social isolation and total negative relationships [ρ(22) = -0.44, p = 0.042]. Number and quality of relationships were associated with resident social withdrawal, perceived support, and isolation. High prevalence of isolation and negative relationships demonstrate the need for interventions. [Journal of Gerontological Nursing, 42(11), 9-13.].

Social-Professional Networks in Long-Term Care Settings With People With Dementia: An Approach to Better Care? A Systematic Review

BACKGROUND

Dementia is a syndrome associated with stigma and social isolation. Forty-two percent of people with dementia in the United States and almost 40% in the United Kingdom live in assisted living and residential care facilities. Up to 90% of residents with dementia experience behavioral and psychological symptoms of dementia (BPSD). Currently psychotropic drugs are often used to manage BPSD, despite the drugs' limited efficacy and adverse effects. Even though psychosocial approaches are as effective as medical ones without side effects, their uptake has been slow. Social networks that investigate the structure of relationships among residents and staff may represent an important resource to increase the uptake of psychosocial approaches and facilitate improvements in care.

OBJECTIVES

To conduct a systematic review of social network studies set in long-term care (LTC), including residents with dementia, and identify network factors influencing the care available to residents.

METHOD

Peer-reviewed articles across CINAHL, EMBASE, IBSS, Medline, PsychInfo, Scopus, and Web of Science were searched from January 1994 to December 2014 inclusive, using PRISMA guidelines. Studies included those examining social networks of residents or staff in LTC.

RESULTS

Nine articles from studies in the United States, Europe, Asia, and Australia met search criteria. Resident networks had few social connections. One study proposed that residents with high centrality be encouraged to welcome new residents and disseminate information. The high density in 2 staff network studies was associated with the cooperation needed to provide care to residents with dementia. Staff's boundary-spanning led to higher-status nurses becoming more involved in decision-making and problem-solving in one study. In another, the outcome was staff treating residents with more respect and actively caring for them.

CONCLUSION

These studies suggest interventions using a network approach may improve care services in LTC.

Residents Perceptions of Friendship and Positive Social Networks Within a Nursing Home

PURPOSE OF THE STUDY

(i) To describe nursing home residents' perceptions of their friendship networks using social network analysis (SNA) and (ii) to contribute to theory regarding resident friendship schema, network structure, and connections between network ties and social support.

DESIGN AND METHODS

Cross-sectional interviews, standardized assessments, and observational data were collected in three care units, including a Dementia Specific Unit (DSU), of a 94-bed Sydney nursing home. Full participation consent was obtained for 36 residents aged 63-94 years. Able residents answered open-ended questions about friendship, identified friendship ties, and completed measures of nonfamily social support.

RESULTS

Residents retained clear concepts of friendship and reported small, sparse networks. Nonparametric pairwise comparisons indicated that DSU residents reported less perceived social support (median = 7) than residents from the other units (median = 17; U = 10.0, p = .034, r = -.51), (median = 14; U = 0.0, p = .003, r = -.82). Greater perceived social support was moderately associated with higher number of reciprocated ties [ρ(25) = .49, p = .013].

IMPLICATIONS

Though some residents had friendships, many reported that nursing home social opportunities did not align with their expectations of friendship. Relationships with coresidents were associated with perceptions of social support. SNA's relational perspective elucidated network size, tie direction, and density, advancing understanding of the structure of residents' networks and flow of subjective social support through that structure. Understanding resident expectations and perceptions of their social networks is important for care providers wishing to improve quality of life in nursing homes.