Problems identified by dual sensory impaired older adults in long-term care when using a self-management program: A qualitative study.

Lieve Roets-Merken,Maud Graff,Marianne Dees,Myrra Vernooij-Dassen,Gertrudis Kempen,Pieter Hermsen,Sytse Zuidema

doi:10.1371/journal.pone.0173601

Abstract

ObjectiveTo gain insights into the problems of dual sensory impaired older adults in long-term care. Insights into these problems are essential for developing adequate policies which address the needs of the increasing population of dual sensory impaired older adults in long-term care.MethodsA qualitative study was conducted in parallel with a cluster randomized controlled trial. Dual sensory impaired older adults in the intervention group (n = 47, age range 82–98) were invited by a familiar nurse to identify the problems they wanted to address. Data were taken from the semi-structured intervention diaries in which nurses noted the older adults’ verbal responses during a five-month intervention period in 17 long-term care homes across the Netherlands. The data were analyzed using descriptive statistics and qualitative content analysis based on the Grounded Theory.FindingsThe 47 dual sensory impaired older adults identified a total of 122 problems. Qualitative content analysis showed that the older adults encountered participation problems and problems controlling what happens in their personal environment. Three categories of participation problems emerged: (1) existential concerns of not belonging or not being able to connect with other people, (2) lack of access to communication, information and mobility, and (3) the desire to be actively involved in care delivery. Two categories of control-in-personal-space problems emerged: (1) lack of control of their own physical belongings, and (2) lack of control regarding the behavior of nurses providing daily care in their personal environment.ConclusionsThe invasive problems identified indicate that dual sensory impaired older adults experience great existential pressures on their lives. Long-term care providers need to develop and implement policies that identify and address these problems, and be aware of adverse consequences of usual care, in order to improve dual sensory impaired residents’ autonomy and quality of life.

Highlights

The prevalence of dual sensory impairment (DSI) among older adults in long-term care (LTC) facilities has increased rapidly from 12% in 2005 to 33.9% in 2016 and is expected to continue to grow strongly [1, 2]
Three categories of participation problems emerged: (1) existential concerns of not belonging or not being able to connect with other people, (2) lack of access to communication, information and mobility, and (3) the desire to be actively involved in care delivery
Research showed that DSI residents in LTC who were involved in activities did not have a higher mortality than a comparable group of non-DSI residents, while residents with DSI who were not involved in activities had a 51% higher mortality [8]

Summary

Introduction

The prevalence of dual sensory impairment (DSI) among older adults in long-term care (LTC) facilities has increased rapidly from 12% in 2005 to 33.9% in 2016 and is expected to continue to grow strongly [1, 2]. The LTC-population in the Netherlands has greatly altered; from being a relatively independent 70+ population, it has become an 85+ population suffering from a complex of aged-related diseases, highly dependent on professional care [9] It is not clear if the current LTC-policies towards sensory impairment are still adequate for the current population. For the pre-millennium LTC population, a sensory impairment was primarily an individual problem that could be addressed at an individual level by medical treatment, device provision, and possibly a psychosocial rehabilitation program. After having completed this ‘cure and care’ program, LTC residents with their (often single) sensory impairment, were expected to be able to cope independently and to self-manage daily activities adequately. Expertise centers for aged care and hearing or visual rehabilitation recommend an annual screening of both hearing and vision as best practice, with, if necessary, a referral to relevant medical specialists or device providers, supplemented with nurse attention for correct use of the devices [10, 11]

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Conclusion