The impact of the COVID-19 pandemic on nursing home professionals: results of the RESICOVID project

OBJECTIVES

The situation caused by the COVID-19 pandemic has had an impact on the mental, physical, and social health of nursing home staff. The operations and protocols of long-term care facilities had to be adapted to a new, unforeseen, and unknown situation in which a devastating and highly contagious disease was causing large numbers of deaths. The aim of this study was to determine the cumulative impact of the COVID-19 pandemic on care, technical, coordinating-supervisory, and managerial staff working in nursing homes.

METHODS

Correlation analysis and between-group comparisons were carried out to study the relationship between burnout scores, emotional balance, and organic and behavioral symptoms.

RESULTS

The results indicate high levels of burnout and psychological exhaustion. Management professionals displayed higher levels of organic and behavioral symptoms than other professional categories in the same care settings. Despite this negative symptomatology, most professionals showed a positive emotional balance.

CONCLUSION

The need to develop intervention programs to improve the mental, physical, and occupational health of the staff in nursing homes, considering the needs of different professional categories, is emphasized.

Effectiveness of a Supervised Group-Based Otago Exercise Program on Functional Performance in Frail Institutionalized Older Adults: A Multicenter Randomized Controlled Trial

BACKGROUND AND PURPOSE

Because of its high prevalence and association with negative health-related outcomes, frailty is considered one of the most important issues associated with human aging and its mitigation is among the essential public health goals for the 21st century. However, very few studies have focused on institutionalized older adults, despite the knowledge that frailty can be reversible when identified and treated from its earliest stages. Therefore, the objective of this study was to evaluate the effects of a supervised group-based multicomponent exercise program intervention with or without oral nutritional supplementation on functional performance in frail institutionalized older adults.

METHODS

This was a multicenter randomized controlled trial study with a 6-month intervention period. A total of 111 frail institutionalized older adults (75 years or older) who met at least 3 of the 5 Fried frailty criteria were randomly allocated to the control group (CG; n = 34, mean age = 87.3 ± 5.3 years), a supervised group-based multicomponent Otago Exercise Program group (OEP; n = 39, mean age = 86 ± 5.9 years), or a supervised group-based multicomponent exercise program intervention with oral nutritional supplementation (OEP+N; n = 38, mean age = 84.9 ± 6 years). Measurements included the Timed Up and Go test (TUG), Berg Balance Scale (BBS), Short Physical Performance Battery, repeated chair stand test (STS-5), handgrip strength (HGS), 10-m walking test, and 6-minute walking test, both at baseline and after the 6-month intervention period.

RESULTS AND DISCUSSION

The between-group analysis by 2-way analysis of covariance showed significant improvement in the TUG [{OEP vs CG: -8.2 seconds, 95% CI [-13.3 to -2.9]; P < .001}; {OEP vs OEP+N: -7.3 seconds, 95% CI [-12.4 to -2.2]; P = .002}], BBS [{OEP vs CG; 8.2 points, 95% CI [5.2 to 11.2]; P < .001}; [{OEP+N vs CG: 4.6 points, 95% CI [1.6 to 7.6]; P < .001}; {OEP vs OEP+N: 3.5 points, 95% CI [0.6 to 6.5]; P = .011}], and HGS [{OEP vs CG: 3.4 kg, 95% CI [1.5 to 5.3]; P < .001}; {OEP+N vs CG: 3.6 kg, 95% CI [1.7 to 5.5]; P < .001}]. Additionally, the within-group analysis showed a significant improvement in the TUG (-6.9 seconds, 95% CI [-9.8 to -4.0]; P < .001) and BBS (4.3 points, 95% CI [2.6 to 5.9]; P < .001) in the OEP group. A significant decrease in the BBS and HGS was shown in the CG.

CONCLUSIONS

A 6-month supervised group-based multicomponent exercise intervention improved the levels of mobility, functional balance, and HGS in frail institutionalized older adults. Further research will be required to evaluate the nutritional supplementation effects on functional performance to better determine its clinical applicability for tackling frailty.

Capacity or Necessity? Comparing the Socio-Economic Distribution of Productive Activities Between Italy and South Korea

Much productive ageing research aims to identify the conditions under which older adults engage in productive roles within and outside the family. This study conceptualises two individual-level explanations for productive participation: capacity and necessity. I hypothesise that whether capacity or necessity prevails across different socio-economic groups depends on the degree of social protection guaranteed by pensions and long-term care systems, which varies across countries. Drawing on data from the SHARE and KLoSA surveys, this study compares socio-economic gradients in full-time work and informal caregiving across cohorts of men and women aged 50-75 in Italy and South Korea in 2006/07 and 2014/15. In Italy, where later-life social protection is generous, productive engagement is more common among wealthier and higher-educated individuals, who have greater capacity to engage in productive roles. In Korea, where social protection is limited, working is more common among socio-economically disadvantaged women, who have higher necessity to remain economically productive.

The Role of Generativity in Later Life in the Case of Productive Activities: Does the Type of Active Aging Activity Matter?

Active aging has been associated with both personal and social benefits. However, active aging encompasses a broad range of activities, including self-oriented and community-oriented ones. The aim of this study was to explore to what extent generativity is a key factor in differentiating between both types of activity, and to contribute to the theoretical and methodological literature on generativity as a multidimensional concept relevant to later life participation in certain activities related to an active style of living. A sample of 549 older adults who engaged in two types of self-oriented activity (leisure activities and students of University of the Third Age programs) and two types of community-oriented activity (formal volunteering and political activism) participated in this study. Following a mixed-method strategy, we administered several qualitative and quantitative measures of generativity, including generative concern, generative goals, and perceived cultural demand. Our results showed that participants who engaged in self-oriented and community-oriented activities differed on all dimensions of generativity. Differences in generativity were particularly high regarding cultural demand and future generative goals, which were far more frequently mentioned by political activists and volunteers than by university of the third age students and those pursuing leisure activities. Overall, our findings suggest that generativity plays a role in older adults' participation in some (but not all) active aging activities in later life, and that our understanding of generativity in later life gains from a multidimensional assessment of the concept.

Psychological and functional impacts associated with restrictions in long-term care facilities (LTCF) due to the COVID-19 pandemic: A multicentre study

Objectives: To analyze the impacts of the restrictions implemented in LTCF during the COVID-19 pandemic on the psychological and functional status of older adults. Design: A retrospective multicentre study is designed. We hypothesize that the negative effects of the restrictions will lead to a higher rate of decline between the measures taken immediately before and after the lockdown than between the two measures taken before the lockdown. Setting and participants: 365 participants recruited in four Spanish LTCFs in Galicia and Valencia.Methods: Impacts of restrictions on cognitive (MMSE), affective (GDS) and functional status (Barthel index, Tinetti) were analyzed by Linear Mixed Models with random intercepts, random slopes, and personal and contextual factors as covariates.Results: Social measures covaried significantly with the cognitive and functional status but did not predict longitudinal change. MMSE, Barthel index and Tinetti scores decreased significantly across pre- and post-lockdown measurement times, but only the Tinetti scores showed a specific impact of the restrictions.Conclusions: Only performance-based functional measures showed the real impact of restrictions. The findings highlight the importance of having data from several pre-lockdown measurements to enable identification of changes that can be causally attributed to the restrictions. The findings also support the resilience of older adults in mitigating the effect of the restrictions.

Aging in Place: Connections, Relationships, Social Participation and Social Support in the Face of Crisis Situations

OBJECTIVES

We seek to identify active coping strategies used by older adults to face the pandemic and to deal with daily stressors, and to clarify which factors had an effect on stress, positive emotions and depression in active and healthy community-dwelling older adults in the first and second year of the pandemic in Costa Rica.

METHODS

Participants were living in their own homes in Costa Rica (n = 218, mean age 69.96, 82.1% women). Participants were interviewed by phone and answered an online survey, which included socio-demographic information, mental health variables such as stressors (perceived health and fear of COVID-19, illness, perception of pandemic gravity), loneliness (whether they felt lonely and how often they felt lonely), access to Information and Communication Technologies, socio-emotional coping variables, social participation and physical activity level during the pandemic.

RESULTS

Positive socio-emotional indicators related to well-being such as self-efficacy, social support, perceived health and proactive behavior were high. Negative well-being indicators such as perceived stress, emotional COVID-19 fear and loneliness showed low values in the sample studied during both years. We found significant relations across the dependent variables (perceived stress, positive emotions and depression) by studying the psychological well-being coping strategies.

CONCLUSIONS

Findings highlight the importance of coping strategies and social participation in the capacity of older adults to mitigate the negative psychological consequences of crisis situations and provide evidence of "aging in place".

Engaged Scholarship in Gerontology: Frank Caro's Lifetime Contributions

Dr. Francis G. Caro, retired Professor of Gerontology at the University of Massachusetts Boston, Co-editor (1996-2005) and Editor-in-Chief (2005-2016) of the Journal of Aging and Social Policy, passed away on October 2, 2020. Caro dedicated most of his nearly 60 years of academic and professional activity to gerontology and services for older adults. This article offers a review of his contributions in four central areas of gerontology: the strengthening of long-term services and supports through integration of home care services with other domains, the expansion of how productive aging was socially understood and economically valued, the importance of rigorous program evaluation and ongoing methodological innovation, and the significance of age-friendly cities and communities, both in the United States and internationally. This review of Caro's work highlights his integral role in helping to place several topics on the gerontological agenda that are still relevant today, establishing him as an important contributor to the field. He also exemplified productive aging and how scholarship can be theoretically rigorous but also applied in meaningful ways to make a difference in individual lives and within communities.

Older Women’s Loneliness and Depression Decreased by a Reminiscence Program in Times of COVID-19

The confinement caused by the current COVID-19 pandemic protects physical health, but in turn, has a long-lasting and far-reaching negative psychosocial impact; anxiety, stress, fear and depressive symptoms. All of these have a particular impact on vulnerable older people, putting them at serious risk of loneliness. Women report feeling lonelier than men, affecting women to a greater extent. The present study aims to analyze the efficacy of an integrative reminiscence intervention in older women living in nursing homes to reduce the effects of loneliness and depression after COVID-19. 34 older women living in nursing homes are included into study and were divided into intervention group (N = 14) and control group (N = 20). Results showed a significant reduction in perception of loneliness, depression and better positive affects, after the intervention. The pandemic has not yet finished and the most affected group has been the people living in nursing homes. These results show the need for evidence of interventions that can help the recovery of these people who have been so affected. The effects of loneliness during confinement and its psychological effects can be mitigated through such programs.

Factors Influencing Intention to Technological Use in Older Adults. The TAM Model Aplication

The use of digital technology by older adults has improved in recent years in response to the need for their functional adaptation to an increasingly technological social context. Understanding this type of technological adaptation has recently become an important field of inquiry in both social and gerontological studies. Working within this framework, the aim of this study is to identify the main determinants that influence the intention of older people to use digital technology in their daily lives, using the Technological Acceptance Model. A study was carried out with the participation of 1155 people over 65 years of age in Spain. Confirmatory Factor Analysis and structural equation models (SEM) were performed. The results show that the TAM is a useful model to explain the intention of older adults to use Digital Technology, showing a high predictive power, highlighting Perceived Usefulness and Perceived Ease of Use as the main predictor variables.

Impact of the COVID-19 Lockdown on a Long-Term Care Facility: The Role of Social Contact

(1) Background: Long-term care facilities (LTCFs) have been harmed by the coronavirus, and older adults have remained isolated for a long time with many restrictions. The aim of this study was to measure the decline in cognitive, functional, and affective status in a care facility after the lockdown in the first wave of the COVID-19 pandemic and to compare it with previous measures in order to determine if this decline was accelerated. (2) Methods: Ninety-eight participants were recruited. Data from three retrospective pre-lockdown assessments and an additional post-lockdown assessment were analyzed. Mixed ANOVA analyses were performed according to the Clinical Dementia Rating levels, considering social-contact frequency during the lockdown as a covariate. (3) Results: The cognitive and functional scores were lower and depression scores were higher after the strict lockdown, accelerating a general pattern of decline that was already present in LTCF residents. The frequency of social contact eliminated the measurement differences in the cognitive and functional scores and the group differences in depression scores. (4) Conclusions: The effects of the SARS-CoV-2 lockdown in an LTCF were mediated by the frequency of contact. Clinical implications: Preventive measures must be taken to ensure social contact with relatives and friends and reduce the negative consequences of social isolation in LTCFs.

Effects of an Educational Program for Professional Caregivers on Behavioral Alterations in Nursing Home Residents: Pilot Study

This pilot study aims to analyze the effectiveness of a type of non-pharmacological intervention such as the educating and training of professional caregivers on behavioral alterations and prescription of psychotropic drugs of older adults in nursing homes. One hundred and forty-five people from two nursing homes were randomized to either treatment (educational training program for healthcare professionals) or a no-treatment group. Twenty-two professional caregivers in the experimental group received 20 h of a training program. Five data collection points were collected (pre and post, and three follow-ups, all six months apart). Intervention consisted of the behavioral alterations and psychopharmacological treatment. The analysis of variance for repeated measures showed significant differences in the time-group interaction for the educational program's effectiveness in reducing behavior alterations and psycho-pharmaceuticals' record. The results show that an improvement in the educating and training of professional caregivers can reduce behavioral alterations (F3,407 = 9.29, p < 0.001, η2= 0.063) and prescription of psychotropic drugs (F2,10 = 18.90, p < 0.001, η2 = 0.117). In addition, these effects are maintained over time. Educating health professionals on ways to care for residents who present behavioral alterations may be one alternative for improving the quality of care that residents receive. Non-pharmacological interventions, besides being individualized and adapted to the needs and experiences of individuals, achieve effects that last longer at low cost. An educational program shows new alternatives to pharmacological intervention, achieving a reduction in behavioral alterations without the costs and effects that psychopharmaceuticals entail.

Testing a Proactive Model of Successful Aging Among Older Adults in Costa Rica and Spain

The purpose of this study is to examine successful aging among Spanish-speaking older adults in Costa Rica and in Spain using the proactive framework proposed by Kahana et al. (2014). More specifically, we hypothesized that older adults' life satisfaction would be positively associated with the frequency and perceived level of social support, spirituality/having purpose in life, and the use of proactive physical, cognitive, and social self-care behaviors. Our results confirmed these hypotheses, not only for the overall group of participants, but also separately for older adults in Costa Rica and in Spain. The present study contributes to the literature of successful aging among older adults, by examining the protective factors associated with life satisfaction among Spanish speaking older adults in Costa Rica and in Spain. It identifies specific protective factors (spirituality/purpose in life, social support, and self-care) associated with the values and preferences held by participants in the study.

Loneliness and social support: Differential predictive power on depression and satisfaction in senior citizens

The lack of social support and the feelings of loneliness among older adults are associated with physical and mental health negative outcomes. This study attempts to test for their differential predictive power on depression and satisfaction in seniors. Data were drawn from a sample of 335 older adults ranging from 55 to 80 years old, with a mean age of 63.97 years (standard deviation = 5.56) attending a learning program at the University of Valencia during the academic year 2014-2015. In addition to health and wellbeing outcomes, we used the Functional Social Support Questionnaire DUKE-UNC, and two scales of loneliness, the de Jong Gierveld Loneliness Scale and the University of California Loneliness Scale version 3. Using structural equations models with Mplus, two models were proposed to assess the predictive power of social support and loneliness on wellbeing outcomes, specifically life satisfaction and depression, while controlling for health. Results confirm the negative association between loneliness and satisfaction with life and the positive one with depression.

Validity of the de Jong Gierveld Loneliness Scale in Spanish older population: competitive structural models and item response theory

Loneliness is a subjective measure of one's state of mind and the negative feelings about one's level of social contact, which usually involves an unwanted discrepancy between existing and desired relationships. It is measured through self-reported questionnaires, among which a widely used one is the de Jong Gierveld Loneliness Scale (DJGLS). Although it has been previously tested and proven to be a reliable tool for measuring loneliness of Spanish older people, some relevant research questions remain unsolved. Therefore, this article aims to present a validity study of the Spanish version of the DJGLS for its use with older people, by establishing its factorial validity; studying the adequateness of a Rasch model underlying participants' responses; offering evidence of its reliability; and testing for convergent and discriminant validity. Data were obtained in a survey conducted with older adults attending Lifelong Learning programs in Valencia (Spain). The sample consisted of 335 people aged 55 years or older. Sociodemographic data were collected, and loneliness was measured with the DJGLS and the UCLA Loneliness Scale. Results have supported a unidimensional substantive structure, but with minor method effects associated with negatively worded items. In terms of multidimensional IRT analysis, the 2 Parameters Logistic Model fitted the data well and offered better information functions than the Rasch model. Reliability and criterion-related validity estimates were adequate.

INFORMACIÓN Y EXPOSICIÓN INDIRECTA PARA REDUCIR ESTEREOTIPOS HACIA EL ENVEJECIMIENTO

Abstract.Purpose: The Image that society has about older people has been built on a base of stereotypes, far away from reality. This social image will have a determinant influence on attitudes and behaviors from all those people related with them, including health care professionals. It should be mandatory to eradicate negative stereotypes against aging during university formation, and in this practice get sensitive professionals who will attend people in their final state of life. Method: the treatment “Information plus indirect experience” was set throw the viewing of the short film “Como un Rolling” (Castilla, 2013). This film exposes the concept of active aging, and had the purpose to become the way of changing stereotype toward aging and older people in university students. Using a non-probabilistic sampling 187 students were selected (age: M=21.88, SD=4.15) from Spain (N= 112) and Costa Rica (N=75). The “Diferencial Semántico del Envejecimiento” (Villar, 1997) and the CENVE scale (Blanca, Sánchez, Tríanes, 2005) were applied before and after watching the film. t test for related samples and correlation analysis on the variables studied were run. Furthermore, the concept of active aging was qualitatively analyzed before and after viewing the documentary. Results: Higher values were identified at the level of negative stereotypes before viewing the documentary, significant differences between pre and post measures of scales were found, identifying a decrease of negative stereotypes after exposure and more positive views of aging. No significant differences between countries were found. Conclusions: It is possible to sensitize young people and get changes in stereotypes from a combined program that mixed information and experience.Keywords: Stereotypes, Old People, Aging, University Students.Resumen.Propósito:La imagen que la sociedad tiene de las personas mayores se ha construido sobre una base de estereotipos, en su mayoría lejanos a la realidad. Esta imagen social tendrá una influencia determinante sobre las actitudes y comportamientos de todos aquellos que de una forma u otra se relacionan con ellos, incluidos aquellos que van a trabajar en tareas de cuidado. Durante la formación universitaria, es necesario disminuir los estereotipos negativos hacia la vejez y el envejecimiento de los futuros profesionales que atenderán a las personas al final de su ciclo vital. Método: La intervención “Información más experiencia indirecta” a partir del visionado de un corto-documental “Como un Rolling” (dir: P. Castilla, 2013) que expone el concepto de envejecimiento activo y muestra diferentes ejemplos, iba dirigida a lograr un cambio en los estereotipos hacia la vejez y el envejecimiento en estudiantes universitarios. Mediante un muestreo no probabilístico se seleccionaron 187 estudiantes (Edad: M=21.88, DE=4.15) de España (N= 112) y de Costa Rica (N=75). Se aplicó el Diferencial Semántico del Envejecimiento (Villar, 1997) y el Cuestionario CENVE (Blanca, Sánchez, Tríanes, 2005) antes y después del visionado. Se realizaron pruebas t para muestras relacionadas y análisis de correlaciones sobre las variables estudiadas. Además, se analizó cualitativamente el concepto de envejecimiento activo antes y después del visionado del documental. Resultados: Se identificaron valores altos en el nivel de estereotipos negativos antes del visionado del documental. Se encontraron diferencias significativas entre las medidas pre y post de las escalas, identificando una disminución de los estereotipos negativos tras la exposición y unas visiones más positivas de la vejez y envejecimiento. No se encontraron diferencias significativas entre las muestras de los países analizados. Conclusiones: Es posible sensibilizar a la población joven y conseguir cambios en los estereotipos a partir de un programa combinado que aúne información y experiencia.Palabras clave: Estereotipos, Envejecimiento, Vejez, Estudiantes Universitarios