The Psychosocial Effects of a Companion Robot: A Randomized Controlled Trial

IntroductionPromoting individuals' health across different life spans has always been key to a holistic nursing practice. Seniors are a diverse population who go through many physical and mental changes as they age. During the last decade, assisted living facilities (ALFs) have dramatically increased in numbers to provide care and living services in a home‐like environment.AimThe aim of this descriptive exploratory study was to explore the quality of life as perceived by seniors who reside in assisted living facilities (ALFs).DesignThis study utilized a descriptive exploratory design to investigate the quality of life of seniors living in ALFs.MethodsSeventeen residents from two ALFs were interviewed to gather their perspectives on the quality of their lives while living in an ALF. The interviews were conducted by the researcher and were audio‐recorded and transcribed verbatim. The data were analysed using thematic analysis.ResultsThree major themes surfaced from residents' descriptions: ‘physical environment’, ‘social environment’ and ‘home‐like atmosphere’. The quality of life in ALFs was found to be predominantly an outcome of the exchange between the personal capability of residents to adapt to changes and the capacity of the facility to meet residents' diverse needs.Patient or Public ContributionParticipants who discussed their quality of life in ALFs provided profound insights into this aspect of their lives. The findings from this study can potentially enlighten ALF stakeholders and enhance the quality of life for seniors residing in these facilities.

BackgroundLiving in residential aged care (RAC) facilities can be passivating and negatively impact residents’ well-being and quality of life. With a growing global population of older adults and an increasing number residing in RAC facilities, it is crucial to address these concerns. Person-centered reablement, which enhances activity and participation through tailored, multidisciplinary strategies, has shown promising results in home settings. However, its implementation in RAC facilities, especially in Sweden, requires further evaluation.This research project will examine whether the reablement intervention in RAC (Re-RAC) impacts activity performance and satisfaction, participation, quality of life, and well-being, in older adults living in RAC facilities. Additionally, the project will evaluate the health-economic effects of the intervention and explore potential associations with the outcomes. A further aim is to describe the experiences of both the participating older adults and RAC facility staff involved in Re-RAC.MethodsThis is a multi-center prospective pragmatic randomized controlled trial has two parallel groups comparing the Re-RAC intervention with usual care. A total of 86 participants are planned to be enrolled. The 8-week intervention will be evaluated using quantitative, qualitative, and health-economic methods. Data will be collected at baseline and after the intervention. Health-economic data will also be gathered 3 months before and after intervention. Primary outcomes are activity performance and satisfaction with performance captured using the Canadian Occupational Performance Measure; secondary outcomes, i.e., health-related quality of life, psychological well-being, and physical activity levels will also be evaluated. Experiences of participants and staff will be captured through individual and focus-group interviews. Cost-effectiveness will be estimated by calculating the cost per quality-adjusted life year gained.Quantitative data will be analyzed using descriptive and comparative statistics; qualitative data will be analyzed using thematic analysis and focus-group methodology.DiscussionThis study evaluates the Re-RAC intervention for older adults in RAC through a real-world pragmatic trial, examining activity performance, satisfaction, quality of life, well-being, and health outcomes for older adults in RAC facilities. The study also explores participant and staff experiences and evaluates cost-effectiveness. The results will offer valuable insights informing the future implementation and assessment of reablement interventions in RAC settings.Trial registrationClinicalTrials.gov, ID: NCT06793501. Registered on 20 January 2025.

A long-term study of elderly people in nursing homes with visiting and resident dogs

The objective of this scoping review is to examine and map knowledge of nursing provisions for self-determination while providing care to clients with cognitive impairment in residential aged care facilities. Maintaining the ability to have choices and to make decisions about daily activities is important for older adults. In residential aged care facilities, nurses' can be challenged to preserve clients' self-determination in favor of ritualistic care routines and a perceived duty to care. Moreover, nurses may perceive that their professional responsibilities to protect clients requires them to guard against decisions that are considered unwise or pose a risk to clients' health or safety. Insight into how nurses negotiate choice with clients with cognitive impairment who are living in a residential care facility will provide an in-depth understanding of the role self-determination plays in clients' lives. The scoping review will consider research and narrative reports on nursing provisions for self-determination in clients with cognitive impairment who are living in a residential aged care facility. The concepts of interest are self-determination and nursing provisions. Self-determination is defined as client choice and nursing provisions are the intentional reactions to clients' expressed choices. This scoping review will aim to locate published and unpublished literature employing a three-step search strategy. Only papers published in English from 1995 onward will be included. Data extracted from included papers will outline details on the participants, context, strategy, activity, and outcomes. Extracted data will be reported in a tabular form and presented narratively to address the review objective.

A survey of nursing homes in the Brisbane area (n=102) showed that 11.8% (12) had a regular Pet Therapy Program (PTP) and 35.3% (36) were interested in having a PTP. Pet Therapy Programs were defined as having a pet walk freely around the institution and available to everyone. This type of program was preferred to a structured program. The most commonly kept pets were dogs, cats, birds and fish, however nursing home residents also fed wild birds and animals. Eighteen nursing home administrators thought the institution had legal liability for the residents, but most were unsure whether the liability covered the animals'. Administrative and professional staff members were responsible for implementing most PTP's (77.8%), however half of the PTP's operating in the institutions were not supervised or evaluated at any time. The main factor determining implementation of a PTP is whether the administrators want one or not. A study of elderly people who still lived in their own homes (n=50) showed that 52% still kept pets. There were no significant differences between those with or without pets and their perceived happiness, life satisfaction, depression or hobbies and interests nor medical problems. There were no significant differences between the no pet and pet owning groups who lived by themselves or with other people. A desexed whippet dog (8 months) was trained for placement as a resident and visiting dog for two nursing homes in the long term study. Three nursing homes in the Brisbane area took part in the long-term study; one (20 females, 11 males) had the visiting dog (each week), the second (24 females, 8 males) had the resident dog while the third (25 females, 7 males) the visiting researcher only (Control). Tension and Confusion were reduced in the nursing home with a resident dog (X2=21.18, df=10, P=0.02; x2=35.42, df=10, P=0.0001 respectively). This group also showed significant decreases in Depression (x2=31.19, df=10, P=0.0005) as did the Control group (x2=29.8, df=10, P=0.0009; x2=23.4, df=10, P=0.0009). Significant increases in Vigour were found in all three nursing homes (Visiting Dog (x2=43.91, df=10, P=0.0005, Resident Dog x2=42.92, df=10, P=0.0005, Control x2=38.52, df=10, P=0.0005). Fatigue decreased significantly in the Visiting and Resident dog groups (X2=21.58, df=10, P=0.02, x2=19.45, df=10, P=0.03) respectively. This longterm study indicates that there are many benefits from having a resident dog in a nursing home. However, if this is not an option, visiting dogs and/or visiting people improve the lives of nursing home residents.

Using WHOQOL-BREF to evaluate quality of life among Turkish elders in different residential environments

Review question/objective The overall objective of this research is to undertake a systematic review of the effects of spending time outdoors in daylight on the psychosocial wellbeing of older adults and family carers. The specific objectives to be addressed are: Which aspects of psychosocial wellbeing are affected by spending time outdoors in daylight in older adults and family carers? To what extent is spending time outdoors in the daylight effective for improving aspects of psychosocial wellbeing in older adults and family carers? Inclusion criteria Types of participants This review will consider studies that include all older adults aged 55 years or more, including those living in a community setting or a residential aged care facility. In addition, this review will consider family carers, who are defined as unpaid relatives or friends of an older person, who help that individual with their activities of daily living. No further inclusion criteria will be applied. Types of intervention(s)/phenomena of interest The intervention or phenomenon of interest is spending time outdoors in daylight. ‘Outdoors in daylight’ is a broad term that encompasses all outdoor environments where participants are exposed, directly or indirectly, to daylight in a natural setting while participating in any type of outdoor activity. For our review, the definition of outdoor activity is simply ‘being outdoors’ in order to capture all types of engagement with outdoor environments. Studies will be excluded if they utilise artificial ‘bright’ light sources or modify the indoor environment to improve light exposure. An absence of activity or indoors activity with no exposure to daylight will be used as a comparator. Types of outcomes This review will consider studies that include objective and/ or subjective measures of the following outcomes: Older adults: • psychosocial well-being: o behavioural disturbances; o cognition; o mood levels; o quality of life; o satisfaction with service provision; and o social interaction. Family carer health: o carer satisfaction; and o carer stress.

To the Editor: The primary goal of the Program of All-Inclusive Care for the Elderly (PACE) is to provide a cost-effective, patient-centered, community-based alternative to nursing home care (NH) for a NH-eligible population.1-4 PACE programs are fully capitated and are therefore responsible for all costs associated with health care.2, 3, 5 Safe and supportive housing can be a critical component of achieving that goal. When care needs for an individual are high, PACE programs might consider assisted living facilities (ALFs) and must weigh the advantages and disadvantages of ALFs against the capabilities of providing care at home (with additional support from PACE) or in a NH. Cost of care is an important consideration. In the United States in 2010, the yearly cost of ALFs was $37,572, and the NH cost was $79,935 for a private room.6, 7 ALFs vary in size and staffing model, but provide a monitored and supportive environment that is generally more homelike than NHs, although the skills and expertise typically available in ALFs have been questioned.8, 9 The comprehensive care oversight may mitigate this, and the case management that PACE provides can offload tasks from and provide assistance to ALFs in managing PACE enrollees who reside there. The aim of this study was to identify factors associated with ALF use by one PACE program and to characterize potential advantages and disadvantages of ALF use within the PACE model. This study was conducted at one PACE site—Hopkins Elder Plus (HEP)—in two parts: cross-sectional examination of patient-level data abstracted from charts at HEP to compare characteristics of PACE enrollees who resided in different settings and qualitative content analysis of three PACE staff focus group discussions to improve understanding of factors associated with the use of ALFs for PACE enrollees. One hundred and twenty-six charts (100% of enrollees in November 2010) were abstracted, and participants were categorized according to four residential types: home alone, home with family, ALF, and NH (Table 1). This analysis showed that participants residing in ALFs and NHs were similar to those living at home except that they were older and more functionally dependent, had been enrolled in PACE longer, and as expected, received no home care. The three focus groups consisted of clinical (n = 7), social work and administrative (n = 8), and recreational and transport (n = 7) staff members who had been working at PACE for an average of 8.2 years. Content analysis revealed that the primary determinants of ALF use were safety concerns for participants and impaired health and limited capabilities of home caregivers. PACE staff members cited several specific examples of individuals for whom these concerns were the primary drivers of ALF use. Cost was also mentioned as an important consideration when making housing recommendations (e.g., ALF vs NH), because PACE programs are typically responsible for much of the cost. Staff members noted that they were aware of the cost differences and were careful to ensure that higher levels of care (such as NH) were truly necessary. Discussions about trade-offs (autonomy and quality of life vs safety and assistance) were also part of these discussions, as well as the “home-like” atmosphere of ALFs. ALFs were also being used frequently for a temporary, monitored living situation to meet a short-term need. This happens “a few times per month,” according to focus group members. Factors such as geographic proximity to family also prompted ALF use (over NH) for short-term needs. This mixed-methods study is the first to provide data on issues related to the use of ALFs by a PACE program. Although older and more functionally dependent, participants living in ALFs were otherwise similar to those living at home, suggesting that other factors influence the decision to use ALFs. The quantity and types of services that PACE provides (home care, visits to day care centers) to certain participants could have influenced who was able to stay at home and who needed ALF or NH. The potential advantages of collaboration between ALFs and PACE include the clinical support that PACE provides, which can fill gaps in the capacity of ALFs to care for frail and medically complex residents whom they would otherwise be unable to manage.8-10 Short-term usage for observation and supervised care (with PACE support) is another novel opportunity with potential advantages to the resident, ALFs, and PACE. In summary, ALFs offer the additional resource of continuously supervised residential care, which can work synergistically with the clinical support and care direction of PACE toward the goal of extending care outside of NHs, meeting individual care needs, and providing high-value care. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Kohli, Arbaje, Leff, Statom, McNabney: study concept and design, acquisition of subjects and data, analysis and interpretation of data, preparation of manuscript. Sponsor's Role: None.

BackgroundPsychotropic medications have been associated with many adverse outcomes in older people living in residential care. Home-like models of residential care may be preferable to traditional models of care and we hypothesized that this model may impact on the prevalence of psychotropic medications. The objectives were to: 1) examine associations between psychotropic medications and quality of life in older adults living in residential care facilities with a high prevalence of cognitive impairment and dementia and 2) determine if there was a difference in prevalence of psychotropic medications in facilities which provide a small group home-like model of residential care compared to a ‘standard model’ of care.MethodsParticipants included 541 residents from 17 residential aged care facilities in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Cross-sectional analyses were completed to examine the above objectives. Quality of life was measured with the dementia quality of life questionnaire (DEMQOL) and the EQ-5D-5L completed by the resident or a proxy.ResultsOverall, 70.8% (n = 380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. An increased number of psychotropic medications was associated with lower quality of life according to DEMQOL-Proxy-Utility scores (β (SE): − 0.012 (0.006), p = 0.04) and EQ-5D-5L scores (− 0.024 (0.011), p = 0.03) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with lower DEMQOL-Proxy-Utility scores (− 0.030 (0.014), p = 0.03) and benzodiazepines were associated with lower EQ-5D-5L scores (− 0.059 (0.024), p = 0.01). Participants residing in facilities which had a home-like model of residential care were less likely to be prescribed psychotropic medications (OR (95% CI): 0.24 (0.12, 0.46), p < 0.001).ConclusionsAn increased number of psychotropic medications were associated with lower quality of life scores. These medications have many associated adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care. Home-like models of residential care may help to reduce the need for psychotropic medications, but further research is needed to validate these findings.

Successful ageing theories suggest the potential for wellbeing to improve with age. Indeed, rates of depression have been shown to be lower amongst elderly residing in the community compared to younger adults. Unfortunately, the same cannot be said for elderly living in Residential Aged Care facilities (RACFs). Prevalence data indicates rates of depression between 16-50% in Australian RACFs. Moreover, rates of subthreshold depressive symptoms have been reported to be between 10-70%. Of concern, this pervasive and debilitating mental illness has been shown to not only diminish individuals’ quality of life, but also increase their risk of mortality. Although the high level of comorbidity between dementia and depression goes some way towards explaining the increased prevalence of depression in this cohort, research has shown that rates of depression amongst cognitively-intact elderly residing in RACFs are also substantially higher than community-based elderly. A range of biopsychosocial factors have been suggested to account for the increased prevalence of depression in this population; however, the real challenge is to determine how RACFs can create the conditions to reduce mental illness and maximise wellbeing. To date, the focus has been on managing medical illness in the elderly, with early theories of successful ageing emphasising physical illness as the key factor in depleting elderly sense of wellbeing. More recently, psychosocial factors such as self-efficacy, personal mastery and social engagement have been shown to be central to maintaining a sense of wellbeing and reducing the risk of mental illness, particularly depression. Music Therapy and Animal-Assisted Activities are two psychosocial treatments increasing in popularity in many RACFs in Australia. These interventions are typically implemented as aspects of a suite of diversional therapies offered to enrich the residential care environment. Proponents suggest that the interventions not only reduce depression and promote general mental health and wellbeing, but also reduce anxious/agitated behaviours and maintain physical and cognitive abilities. To date, although some favourable findings have been reported for both interventions, research has generally lacked methodological rigour. Moreover, little is known about the effectiveness of the interventions in cognitively-intact elderly samples. The high prevalence of depression in RACFs, and the well-established negative association between depression and wellbeing, makes it ideally suited as a target for intervention amongst this population. To this end, the aim of this thesis was to first characterise the clinical presentation of subthreshold and clinical depression in cognitively-intact elderly using a range of self-report and objective indices; and second, to explore the effectiveness of Music Therapy and Animal-Assisted Activities to reduce depressive symptoms. Participants were recruited from 15 RACFs in Melbourne, Victoria, Australia. Using a Randomised Controlled Trial (RCT) design, each facility was randomly allocated an intervention: Treatment as Usual, Animal-Assisted Activities or Music Therapy. Participants in facilities allocated to an intervention participated in twice-weekly, hour long group therapeutic interventions for four weeks, facilitated by registered therapists’ in the respective interventions. The total sample comprised 96 (84 years ± 6.91 years) cognitively-intact elderly (SMMSE = 26.6 ± 2.62) with varying levels of depression as assessed by GDS-15 scores (score range = 0-13) and clinical interview. Following screening, pre- and post-intervention data for affective (GDS-15, BHS, HADS), quality of life (AQoL) and cognitive functioning (neuropsychological and electrophysiological measures) was collected. Significant differences in the clinical presentation of depression between non-depressed, subthreshold and clinically depressed elderly were observed. Trends consistently revealed higher levels of impairment across affective, quality of life and neuropsychological indices amongst participants in the subthreshold group relative to those with no depressive symptomatology. Participants with clinical depression were shown to have significantly poorer perceptions of quality of life and affective and cognitive functioning relative to participants with no depression and subthreshold depression. Neither of the psychosocial interventions significantly improved affective outcomes relative to Treatment as Usual; however, trends suggested improvements in executive functioning for both Music Therapy and Animal-Assisted Activities relative to Treatment As Usual amongst clinically depressed participants. The findings have implications for the diagnosis and management of depression in Residential Aged Care settings.

Background Living in residential aged care (RAC) facilities can have a passivating effect on older adults. Reablement is an approach to increase activity and participation in daily life. However, research on reablement in RAC facilities remains limited, making further research necessary. Aims/Objectives This study aimed to investigate the feasibility of an 8-week reablement programme, Reablement in Residential Aged Care (Re-RAC), prior to a planned randomized controlled trial (RCT). Material and Methods Re-RAC aligns with the Swedish RAC context and international reablement principles. Qualitative and quantitative data on occupational performance, physical activity, psychological well-being, quality of life, adherence, and residents’ and staff experiences were collected at an RAC facility in Sweden. Descriptive statistics and content analysis were used. Results Six residents and 12 staff participated in the intervention. The methodology and intervention procedures were feasible overall. Participants requested more regular occupational therapy support, and staff requested support to motivate participants. Conclusions This study demonstrates that Re-RAC was a feasible and well-accepted intervention in a Swedish RAC facility, although some areas for improvement were identified. Maintaining motivation was highlighted, and extended support will be incorporated. Significance This study provides practical guidance for reablement in RAC facilities, emphasizing resident motivation and staff engagement.

The demographic change with respect to the ageing of the population has been a worldwide trend[...]

Improving or maintaining quality of life (QoL) is an important aim for caring for people with dementia living in residential aged care facilities (RACFs). This study aimed to investigate the effect of a specific intervention, the Medication Management Consultancy (MMC), on the QoL of residents of RACFs in Western Australia, and to examine the association between psychotropic medications and QoL. A before-after study was conducted. Staff from four RACFs participated in the MMC, and 56 residents with dementia from these RACFs were included. The MMC consisted of an online interactive staff education training course comprising educational videos, and a case study encompassing non-pharmacological strategies, person-centred care for behavioural and psychological symptoms of dementia (BPSD), and strategies to reduce the use of antipsychotics. Following the training, posters, reference cards, reminder stickers, administration of the Older Age Psychotropic Quiz (OAPQ), and 30-min video conferences with action groups in RACFs were utilised. At baseline (T0), QoL, neuropsychiatric symptoms (NPS) and staff distress, cognition, and activities of daily living were assessed by QoL in Alzheimer's Disease (QoL-AD), Neuropsychiatric Inventory-Questionnaire (NPI-Q), Standardised Mini-Mental State Examination (SMMSE) and Bristol Activity of Daily Living Scale (BADLS), respectively, and repeated at 6 (T1) and 12 months (T2). Medication data were obtained from residents' medication charts. At baseline, of the 56 participants, 33 completed the study. Compared with baseline (31.2, 95% confidence interval [CI] 28.9-33.6), QoL significantly improved at 6 months (33.5, 95% CI 30.9-36.0; p<0.001) but not from baseline to 12 months (31.09, 95% CI 28.5-33.7; p=0.58). The NPI-Q severity (residents) significantly improved from 9 (interquartile range [IQR] 11) at T0 to 6 (IQR 9.5) at T1 (p=0.014) and to 7 (IQR 11) at T2 (p=0.026). The medians of NPI-Q distress (staff) significantly improved from 12 (IQR 13.5) at T0 to 8 (IQR 9) at T1 (p=0.013) and to 6 (IQR 11.5) at T2 (p=0.018). Monthly doses of antipsychotics declined significantly by 51.8% at 6 months (p=0.003) and by 43.5% at 12 months (p=0.003); antidepressant doses declined significantly by 25.4% at 6 months (p=0.013) and by 39.4% at 12 months (p=0.016); benzodiazepines doses remained stable. QoL and use of psychotropics, age, sex, NPI-severity, and BADLS were not correlated. The MMC was associated with improvement in QoL, NPS, staff distress, and reduction in monthly use of antipsychotics and antidepressants among RACF residents. There was no correlation between improved QoL and reduction in use of psychotropic medications, but due to the limitations of our study, this should be confirmed in additional studies.

The current study operationalized, assessed, and evaluated the feasibility and preliminary effects of implementing a person-centered approach to incontinence care for older adults with cognitive decline in residential care facilities (RCFs) in Sweden. Twenty health care workers were purposively sampled from two intervention RCFs. Process outcome was measured as number of assessments conducted for incontinence management. Impact outcome measures were quality of life, basal assessment of incontinence, incontinence actions taken, and personally chosen incontinence aids. A usual care control group RCF was matched by resident case-mix and geographic region. Introduction of a person-centered approach showed an increase in residents' quality of life in the intervention group compared to baseline and the control group. A positive effect was found on the number of urinary incontinence assessments conducted (p < 0.05). In addition, the number of person-centered caring actions (e.g., toilet assistance) was significantly higher during and 6 months after implementation of the person-centered approach. Implementing a person-centered approach in clinical practice focused on incontinence care, quality of care, and quality of life is supported for RCF residents. [Journal of Gerontological Nursing, 44(11), 10-19.].

To describe sleep patterns in older adults living in assisted living facilities (ALFs) and to explore the relationship between sleep disturbance and quality of life, functional status, and depression over 6 months of follow-up. Prospective, observational cohort study. Eighteen ALFs in the Los Angeles area. One hundred twenty-one ALF residents aged 65 and older (mean age 85.3, 86% female, 88% non-Hispanic white). Data were collected at baseline and 3 and 6 months after enrollment. Data collected were demographics, physical and cognitive functioning, depression, quality of life, comorbidities, medications, and subjective (i.e., questionnaires) and objective (i.e., 3 days and nights of wrist actigraphy) measures of sleep. Sixty-five percent of participants reported clinically significant sleep disturbance on the Pittsburgh Sleep Quality Index, and objective wrist actigraphy confirmed poor sleep quality. In regression analyses including sleep variables and other predictors, more self-reported sleep disturbance at baseline was associated with worse health-related quality of life (Medical Outcomes Study 12-item Short Form Survey Mental Component Summary score) and worse depressive symptoms five-item Geriatric Depression Scale at follow-up. Worse nighttime sleep (according to actigraphy) at baseline was associated with worse activities of daily living functioning and more depressive symptoms at follow-up. Sleep disturbance is common in older ALF residents, and poor sleep is associated with declining functional status and quality of life and greater depression over 6 months of follow-up. Studies are needed to determine whether improving sleep in ALF residents will result in improvements in these outcomes. Well-established treatments should be adapted for use in ALFs and systematically evaluated in future research.