Occupational therapy in Australian residential aged care facilities: A systematic mapping review

INTRODUCTION

Australia's population is ageing, resulting in more older adults living in residential aged care facilities. Occupational therapy scope of practice in Australian residential aged care facilities is significantly influenced by the government funding instrument. As the current government funding instrument is administratively inefficient, insufficiently discriminates between residents' care needs and provides perverse incentives, a new funding model is set to be implemented. This creates an opportunity for a review of the current evidence base to support the lobbying of national associations to shape occupational therapy practice. The research question that guided this systematic mapping review was as follows: What is the current state of scholarship about occupational therapy in Australian residential aged care facilities?

METHODS

A search of four databases (CINAHL, Medline, Embase and Scopus) was conducted and 1,617 papers were identified. All papers were screened through a two-phase process: (i) title and abstract review and (ii) full text review, using pre-determined inclusion and exclusion criteria to identify papers relevant to this review. A data extraction tool was designed in Microsoft Excel® and was used to extract data from the included papers.

RESULTS

Twelve Australian articles were published between 1986 and 2020, most frequently authored by an occupational therapist. Included articles were classified into four groups: articles including occupational therapists as participants, articles about occupational therapy practice, articles exploring an occupational perspective of residents and articles with limited exploration of occupational therapy.

CONCLUSION

This review identified that there is a dearth of Australian occupational therapy literature. This creates challenges for occupational therapists seeking evidence to guide their practice to optimise resident health and well-being and for national associations seeking to lobby for the profession. Consequently, there is a crucial need to develop the evidence base to support the profession within this practice setting and, ultimately, residents.

‘It gives you more to life, it's something new every day’: an Interpretative Phenomenological Analysis of wellbeing in older care home residents who keep a personal pet

There is a substantial amount of literature that suggests that animals, and specifically animals kept as pets, can have a positive effect on wellbeing. Research exploring the impact of animals on wellbeing in care homes mainly concerns visiting animals as well as shared communal pets. In light of the lack of research regarding personal pets in care homes, the aim of this study was to explore what the experience of keeping a personal pet in a care home means for residents’ sense of wellbeing. Semi-structured interviews were conducted with seven care home residents who were currently living with their pet in a care home. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Analysis revealed four master themes deemed to be relevant to participants’ wellbeing. these were: ‘sense of self and identity’, ‘responsibility and ownership’, ‘motivation and desire to live’ and ‘feeling content in the care home’. The analysis indicated that living with a personal pet in a care home has the potential to enhance residents’ wellbeing. At the same time, it also found that the benefits of keeping a personal pet may be dependent on specific circumstances, such as the attitudes of staff and fellow residents at the care home. This study indicates that it may be advisable for more care homes to accept personal pets.

Spiritual reminiscence therapy for older people with loneliness, anxiety and depression living in a residential aged care facility, Malaysia: A qualitative approach

OBJECTIVE

To explore how older people with loneliness, anxiety and depression experience a spiritual reminiscence therapy (SRT) program and to explore its acceptability within the Malaysian population.

METHODS

Unstructured observations and a focus-group discussion were carried out with 18 participants involved in a six-week SRT program in a residential care facility in Kuala Lumpur.

RESULTS

Analysis revealed four themes: (i) Enthusiastic participation; (ii) Connections across boundaries; (iii) Expressing and reflecting; and (iv) Successful use of triggers.

CONCLUSIONS

The findings suggest that the process of reminiscence, on which the program was based, was enjoyable for the participants and created opportunities to form connections with other members of the group. The use of relevant triggers in the SRT program that related to Malaysian cultures, ethnicities and religions was helpful to engage the participants and was acceptable across the different religions and ethnicities.

The assessment of anxiety in aged care residents: a systematic review of the psychometric properties of commonly used measures

ABSTRACTBackground:Assessing anxiety among residential aged care facility (RACF) residents is challenging, and it cannot be assumed that valid and reliable measures used within the community are also appropriate for this setting. This review systematically examined the literature to identify which anxiety measures were most commonly used with older adults in RACFs, and determine whether psychometric data support their use within this population.

METHODS

Using the PRISMA guidelines, five electronic databases were searched using key terms and subject headings. The search was limited to literature published in English. Eligible studies utilized an anxiety measure to assess anxiety symptoms among RACF residents. Based on the findings of this search, a critical review of the research into the reliability, validity, and administrative and respondent burden of the most commonly used measures (i.e. used in four or more studies) was conducted.

RESULTS

In total, 1,771 articles were identified, with 50 studies included in this review. Overall, 22 measures were used, with the majority of studies utilizing a clinician-administered or self-report measure. The RAID, HADS, STAI, and GAI were the most commonly used measures. While overall there is a lack of research and consensus into the psychometric properties of these measures within RACFs, strongest evidence of reliability and validity was found for the GAI.

CONCLUSION

Commonly used measures of anxiety within aged care populations are not well validated for this complex subsample of older adults. Strengths and weaknesses of each measure with regards to their usefulness in aged care settings are discussed, with future research areas highlighted.

The Factors Associated With Anxiety Symptom Severity in Older Adults Living in Nursing Homes and Other Residential Aged Care Facilities

Objective: This study aimed to identify the biopsychosocial factors associated with anxiety among a residential aged care sample. Method: A total of 178 residents ( M age = 85.4 years, SD = 7.4 years) with mild cognitive impairment or normal cognition participated. Participants completed the Geriatric Anxiety Inventory (GAI) and a set of measures assessing cognition, depression, self-perceived health, mastery, attachment, perceived social support, social engagement, functional status, the experience of a fall, and other negative life events. Results: Unique correlates of GAI scores were depression, a preoccupied attachment style, lower mastery, cognitive impairment, and lower self-perceived health. Discussion: Most correlates that were uniquely associated with anxiety had little to do with the current environment. More variance was accounted for by stable and lifelong factors. This provides new insights into the characteristics of anxiety within aged care populations, and although preliminary, provides possible targets to prevent and treat anxiety within this setting.

The correlates of anxiety among older adults in nursing homes and other residential aged care facilities: a systematic review

OBJECTIVE

To synthesize and summarize the studies examining the correlates and predictors of anxiety in older adults living in residential aged care.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, five electronic databases were searched using key terms and subject headings, as well as reference lists of relevant papers. The search was limited to peer-reviewed literature published in English. Eligible studies examined the association between at least one correlate/factor and anxiety disorders or symptoms in aged care residents aged 50+ years.

RESULTS

A total of 3741 articles were identified, of which 34 studies (with a total of 1 543 554 participants) were included in this review. Correlates associated with anxiety included pain, use of anti-depressants/lithium, depression, and lower perceived quality of life. Less consistent and/or less studied variables included younger age, female gender, higher educational level, functional dependence, subjective health status, more prescribed medications, impaired vision, insomnia, external locus of control, fear of falling, attachment, hope, meaning in life, and the influence of social, environmental, and staff/policy correlates.

CONCLUSIONS

While several variables were found to have strong associations with anxiety in aged care residents, a number of factors have been examined by only one or two studies. Further research (preferably prospective studies) is therefore needed to reliably confirm findings and to help plan and develop preventative and intervention strategies. Copyright © 2016 John Wiley & Sons, Ltd.

Anxiety and depression in care homes in Malta and Australia: part 2

This cross-sectional comparative study, conducted in two phases, assessed the levels of and factors contributing to anxiety and depression in older people in residential homes in Malta and Australia. Part 1 presented the methodology of this cross-sectional study and presented the quantitative findings; this constituted phase 1. Part 2 presents the qualitative findings on the contributing factors to anxiety and depression and discusses the overall findings. Maltese residents were recruited from four church homes in Malta and Australia and two state residences in Malta; there was a high response rate in phase 2 of 89.4% (n=42, mean age 71.9 years). The residents were all mobile Roman Catholics who had lived in the homes for a minimum of 6 months. Data was collected using audiotaped focus groups. The qualitative data generated three contributing factors: physical functional abilities, adaptation to institutionalisation, and personal outlook towards the future. Mobility was found to foster an active life, which appeared to help residents to control their anxiety and depression. Rehabilitation programmes and facilitation of strategies were recommended to strengthen relationships with family members, room mates, health professionals and pets to help residents live meaningfully. Further cross-cultural longitudinal research would identify the role of other influencing variables such as culture, spirituality and caring relationships.