Adults In Residential Aged Care Research Articles

Registered nurses’ confidence related to undertaking a leadership role in residential aged care: A clinical leadership self-assessment survey

BackgroundThe Australian Royal Commission emphasizes the importance of registered nurse leadership in providing safe, high-quality care to older adults in Residential aged care. Nurse leadership has important ramifications for effective multidisciplinary care as well as recruitment and retention of the aged care workforce. Registered nurse leadership plays a crucial role in enhancing resident outcomes in Residential aged care, however there are limited studies examining self-perceptions of confidence and competence of nurses running Residential aged care, particularly after hours. AimTo examine registered nurse leadership via self-reported confidence and competence in Residential aged care. MethodsA cross-sectional research design with ten facilities in Western Australia was used, including a survey tool that relied on the Clinical Leadership Competency Framework. Cronbach's alpha test was used to ascertain internal reliability and replicability. The Strengthening the Reporting of Observational studies in Epidemiology guidelines was used to guide the study. Inferential statistics were used for data analysis. Data collection occurred over a six-month period, involving registered nurses employed by a single Residential aged care provider in Perth, Western Australia. Participants rated their leadership confidence on a 5-point Likert-type scale ranging from 1 (never) to 5 (all the time). FindingsFrom a sample of 100 registered nurses working in aged care after-hours, 90% reported high levels of self-confidence. The survey results showed that those who have more than 10 years of experience reported highest confidence in managing services. Registered nurses over 50 years old self-reported highest confidence in personal qualities, managing, and improving service domains. DiscussionRegistered nurses run residential aged care, and this time of aged care reform provides an opportunity to examine associations between registered nurse leadership and resident outcomes and provide avenues for improvements in working environments and resident experiences. ConclusionThe findings have important implications for Residential aged care providers in establishing effective leadership mentoring programs to support registered nurses in improving their confidence and ability.

Effectiveness of fall prevention interventions in residential aged care and community settings: an umbrella review

IntroductionPreventing falls is a priority for aged care providers. Research to date has focused on fall prevention strategies in single settings (e.g., residential aged care (RAC) or community settings). However, some aged care providers deliver care, including fall prevention interventions, across RAC and community settings. We conducted an umbrella review to identify what type of fall prevention interventions had the greatest impact on falls outcomes in RAC and community settings.MethodsFive databases were searched for systematic reviews of falls prevention randomised control trials in older adults living in the community or RAC. Data extracted included systematic review methods, population characteristics, intervention characteristics, setting details (RAC or community), and fall-related outcomes (falls, people who have had a fall, fall-related hospitalisations, and fall-related fractures). Review quality was appraised using the Assessment of Multiple Systematic Reviews-2 tool.ResultsOne-hundred and six systematic reviews were included; 63 and 19 of these stratified results by community and RAC settings respectively, the remainder looked at both settings. The most common intervention types discussed in reviews included ‘exercise’ (61%, n = 65), ‘multifactorial’ (two or more intervention types delivered together) (26%, n = 28), and ‘vitamin D’ (18%, n = 19). In RAC and community settings, ‘exercise’ interventions demonstrated the most consistent reduction in falls and people who have had a fall compared to other intervention types. ‘Multifactorial’ interventions were also beneficial in both settings however demonstrated more consistent reduction in falls and people who fall in RAC settings compared to community settings. ‘Vitamin D’ interventions may be beneficial in community-dwelling populations but not in RAC settings. It was not possible to stratify fall-related hospitalisation and fall-related fracture outcomes by setting due to limited number of RAC-specific reviews (n = 3 and 0 respectively).Conclusion‘Exercise’ interventions may be the most appropriate falls prevention intervention for older adults in RAC and community settings as it is beneficial for multiple fall-related outcomes (falls, fall-related fractures, and people who have had a fall). Augmenting ‘exercise’ interventions to become ‘multifactorial’ interventions may also improve the incidence of falls in both settings.

P164: Reminiscence therapy to reduce falls and weight loss: The protocol and outcomes of a pilot trial in residential aged care.

Objective:Falls is the leading cause of injury, and injury-related cognitive decline and death for older adults. Weight loss and malnutrition contribute to the risk of falls through increased frailty, visual and cognitive impairment, and predicts both the severity and recovery time of falls. Psychological and social factors such as isolation, loneliness, cognitive impairment, anxiety and depression are significantly associated with falls and weight loss for older adults. Reminiscence therapy is a psychological intervention that can improve anxiety, mood disorders, cognition and isolation; however, it is not yet known the impact that reminiscence therapy has on the incidence of falls and weight loss. This abstract will present the existing research on reminiscence therapy for the prevention of falls and weight loss, describe a group reminiscence therapy protocol to target these risk factors, and outline preliminary findings from a small pilot trial group therapy program conducted in February, 2023.Results:Data on pre and post incidence of falls and weight loss collected from eHealth records for: 1) 3 months prior to the group, and 2) the 9-week duration of the group will be discussed. Group participants will complete a pre and post Depression Anxiety Stress Scale (DASS21) and provide feedback on the therapy protocol.Conclusion:This presentation will discuss the suitability of a group reminiscence therapy protocol to reduce psychological and social risk factors associated with falls and weight loss for older adults in residential aged care.

Polypharmacy and medicine regimens in older adults in residential aged care

ObjectiveTo describe medicines regimens used by older people living in residential aged care facilities (RACFs). Materials and methodsThis cross-sectional study presents baseline data from a randomised controlled trial in seventeen Australian RACFs that recruited residents aged 65 years and older at the participating facilities. The main outcome measures were to evaluation of medicines utilisation, including the number of medicines, medicine regimen complexity, potential under-prescribing and high-risk prescribing (prescribing cascades, anticholinergic or sedative medicines or other potentially inappropriate medicines) with data analysed descriptively. ResultsMedicines regimens were analysed for 303 residents (76% female) with a mean age of 85.0 ± 7.5 years, of whom the majority were living with dementia (72%). Residents were prescribed an average of 10.3 ± 4.5 regular medicines daily. Most participants (85%) had highly complex regimens. Most residents (92%) were exposed to polypharmacy (five or more medicines). Nearly all, 302 (98%) residents had at least one marker of potentially suboptimal prescribing. At least one instance of potential under-prescribing was identified in 86% of residents. At least one instance of high-risk prescribing was identified in 81% of residents including 16% of participants with at least one potential prescribing cascade. Conclusion(s)Potentially suboptimal prescribing affected almost all residents in this study, and most had highly complex medicines regimens. If generalisable, these findings indicate most older people in RACFs may be at risk of medicines-related harm from suboptimal prescribing, in addition to the burden of administration of complex medicines regimens for facility staff and residents.

Investigating the perspectives of older adults in residential aged care on oral health-related quality of life.

The objective of the study was to explore how older people living in a residential aged care facility perceived that their oral health influenced their food preferences and attitudes towards food, their social interactions and their self-esteem. Poor oral health can have biological, behavioural and social impacts on quality of life among older adults (aged 65+ years). In terms of biological impacts, oral health impairments may cause older adults to avoid many types of foods. This shift in dietary pattern can lead to malnutrition among older people, undermine general health and negatively impact quality of life (QOL). Using a mixed methods approach, quantitative data from the General Oral Health Assessment Index (GOHAI) were explored and supported by data from semi-structured interviews with 10 older adults from a residential aged care facility in Perth, (Australia) to provide insights into their oral health-related quality of life. Thematic analysis of qualitative data was guided by the conceptual framework informed by Locker. The average GOHAI score was 32.9± 3.6, which indicated that participants had an average oral health-related quality of life. Participants coped with oral functional problems by adopting personal strategies and seeking organisational assistance. Some participants appeared to have accepted associated changes to their physical appearance, while others reported significant dissatisfaction and low self-esteem. Perceptions differed on their social interactions at the facility, from being self-conscious about their own oral health problems, to distaste at others' eating behaviours. Poor oral health had negative biological, behavioural and social impacts on daily activities and quality of life among some participants. However, changes at the organisation level may help to support participant QOL.

Tackling malnutrition with a new compact oral nutrient supplement among residents in aged care: a pilot study.

Introduction There is a high prevalence of malnutrition among older adults entering residential aged care (RAC). Aim To determine whether 60 mL of a compact oral nutrition supplement (ONS; daily total: 576 kcal, 35 g protein) consumed four times daily with medication rounds improves malnutrition status, body weight, and body composition measures among older adults in RAC. Methods Residents (n = 20; mean age: 86.7 ± 6.8 years; 50% female) screened for malnutrition (20% malnourished, 80% at risk of malnutrition) using the Mini Nutritional Assessment-short form were recruited during April-June 2021. Participants received 60 mL of an ONS four times daily using the Medication Pass Nutrition Supplement Programme (Med Pass). The ONS intake and participant compliance were recorded. Body mass index, fat, and muscle mass (bioelectrical impedance), malnutrition risk, depressive symptoms, and quality of life were assessed at baseline and following the 18-week intervention. Results Median overall compliance was 98.6%. An ONS intake did not significantly increase mean ± s.d. any body composition measures or improve health and wellbeing outcomes; however, it resulted in increased body weight and body mass index (BMI; 13/20 (65%) participants), body fat mass and percentage (10/16 (63%) participants) and muscle mass (9/16 (56%) participants). Malnutrition risk scores improved in 65% (13/20) of participants, resulting in 10% being assessed as malnourished, 65% at risk of malnutrition, and 25% with normal nutrition status. Discussion Delivery of a compact oral nutrition supplement with the medication round was accepted by residents. Its efficacy in improving malnutrition risk and body composition among residents warrants further investigation.

Re-thinking reablement strategies for older adults in residential aged care: a scoping review

BackgroundThe number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults’ physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness).MethodThis scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored.ResultsFive thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness.ConclusionsThere has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted.Trial registrationProspectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M).

Virtual visits: Reminiscence in residential aged care with digital mapping technologies.

Digital technologies can support reminiscence and lifestyle enrichment in residential aged care. This study explores potential benefits and risks of virtual visits using digital maps, tablet computers and virtual reality technologies. Reminiscence sessions were conducted with metropolitan aged care facility residents (n=7), using digital mapping applications to 'visit' places of personal significance. Residents and family members (n=4) were interviewed. Some older adults found virtual visits valuable and all reminisced in various ways about personal, family and social experiences. Family members felt that virtual visits would be enriching for loved ones and that they supported sharing of life stories. Our results also highlight that VR usability improvements are needed to better suit older people. Virtual visits could offer valuable opportunities for positive reminiscence for some older adults in residential aged care. Digital technologies need to provide better support for older users and people who assist them.

Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study

BackgroundApathy is a common symptom in neurological disorders, including dementia, and is associated with a faster rate of cognitive decline, reduced quality of life, and high caregiver burden. There is a lack of effective pharmacological treatments for apathy, and nonpharmacological interventions are a preferred first-line approach to treatment. Virtual reality (VR) using head-mounted displays (HMDs) is being successfully used in exposure- and distraction-based therapies; however, there is limited research on using HMDs for symptoms of neurological disorders.ObjectiveThis feasibility study aimed to assess whether VR using HMDs could be used to deliver tailored reminiscence therapy and examine the willingness to participate, response rates to measures, time taken to create tailored content, and technical problems. In addition, this study aimed to explore the immediate effects between verbal fluency and apathy after exposure to VR.MethodsA mixed methods study was conducted in a sample of older adults residing in aged care, and 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale (AES), and verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews to assess feedback from participants. Side effects that can occur from using HMDs were also measured.ResultsWe recruited participants from a high socioeconomic status setting with a high education level, and the participation rate was 85% (17/20); most responses to measures were positive. Access to a wide range of freely available content and the absence of technical difficulties made the delivery of a VR reminiscence intervention highly feasible. Participants had improved semantic scores (t14=−3.27; P=.006) but not phonemic fluency scores (t14=0.55; P=.59) immediately after the intervention. Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience, which was indicated by a strong positive relationship between the AES and semantic verbal fluency change scores postminus pre-VR (r=0.719; 95% CI 0.327 to 0.900; P=.003). All participants enjoyed the experience despite 35% (6/17) of participants experiencing temporary side effects.ConclusionsThis study provides initial evidence that it is feasible to use VR with HMDs for therapy to treat symptoms of apathy in older adults in residential aged care. However, there is a need to closely monitor the side effects of HMD use in older adults. Further research is needed using an active control group to compare the use of VR with traditional forms of reminiscence therapy.

Promoting mealtime function in people with dementia: A systematic review of studies undertaken in residential aged care

BackgroundDementia is one of the most prevalent conditions in older adults in residential aged care. Dementia has a significant impact on a person’s ability to eat, drink and participate in mealtime activities. Dementia impacts memory, appetite, gross and fine motor skills, communication skills, mood and social behaviours, all of which can decrease the person’s ability to engage in a meal. ObjectivesThe objective was to review the literature on strategies to promote mealtime function in people with dementia living in residential aged care and assess their effectiveness. The review considered studies reporting outcome measures that related to nutritional status, communication, behaviour and eating skills and ability. DesignSystematic review using the Joanna Briggs Institute review methods. Data sourcesSeven databases (MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, Current Contents, PsycINFO and Allied and Complementary Medicine Database) were searched for research published 2000–2017 in English. Eligible studies included quantitative studies reporting a mealtime intervention delivered to people with dementia in residential aged care compared with standard care reporting nutritional, behavioural or functional outcomes, including observation studies with no comparator. Review methodsStudies were screened and independently appraised by two reviewers using Joanna Briggs Institute (JBI) critical appraisal tools based on study design. Data was extracted from eligible studies using JBI extraction tables that assess study design, population characteristics, intervention and comparator, outcome measures and findings. Results related to mealtime function were tabulated and reported in narrative format. Results136 studies were identified, of which 20 were eligible for inclusion. Studies reported strategies related to: food presentation; meal styles; environment adaptations; skills training; music therapy and animal-assisted therapy. Outcomes included measures of nutritional status, communication and behavioural and psychological symptoms of dementia. Low quality evidence suggested that playing music and introducing fish to the dining room may improve the food intake of people with dementia by a small amount. Montessori and spaced retrieval programs also demonstrated some positive impact on eating skills and nutritional intake. Animal-assisted therapy also demonstrated small statistically significant improvements in weight and body mass index. ConclusionThere is insufficient evidence to highly recommend any specific intervention to improve mealtime functional ability in people with dementia. Further research is required through robust study designs using valid and reliable outcome measures to demonstrate clinically significant effects for mealtime interventions.

Characteristics of older adults with diabetes: What does the current aged care resident look like?

The prevalence of diabetes in older adults in residential aged care (RAC) is twice that of community dwelling older adults. Older adults with diabetes have been highlighted as being at high risk of frailty and malnutrition, particularly when managed on a therapeutic diet. However, assumptions may be based on clinical presentation of our oldest old which may be at conflict with the clinical presentation of younger older adults. The aim of this retrospective audit was to identify the characteristics of aged care residents with diabetes, their comorbidities and malnutrition risk. Residents' with diabetes paper-based records were audited for demographic data, diet code, medical and medication history, malnutrition risk screening scores and anthropometric data. A total of 295 residents with diabetes records were audited across 13 sites in South Australia. Younger older adults (65-74 years) were generally in a healthy weight range (23-30 kg/m2 ) or obese (>30 kg/m2 ) and had gained weight since admission to RAC; whereas the oldest old were more likely to have lost weight and had a lower body mass index range 22.6-28.9 kg/m2 . An unexpected finding was the variability between RAC sites in dietary management of diabetes and potential inappropriate dietary management of malnutrition, as indicated by their food service diet codes. Findings suggest that younger older adults in RAC are more likely to be overweight which is maintained over a typical length of stay. Study findings indicate that diabetes management is inconsistent and highlights the need for mandated RAC menu guidelines.

Aquatic exercise for residential aged care adults with dementia: benefits and barriers to participation.

Pilot work by our group has demonstrated that aquatic exercise has valuable functional and psychosocial benefits for adults living in the residential aged care setting with dementia. The aim of the currents study was to advance this work by delivering the Watermemories Swimming Club aquatic exercise program to a more representative population of older, institutionalized adults with dementia. The benefits of 12 weeks of twice weekly participation in the Watermemories Swimming Club aquatic exercise program were assessed among an exercise and usual care control group of residential aged care adults with advanced dementia. A battery of physical and psychosocial measures were collected before and after the intervention period, and program implementation was also investigated. Seven residential aged care facilities of 24 approached, agreed to participate and 56 residents were purposefully allocated to exercise or control. Twenty-three participants per group were included in the final analysis. Both groups experienced decreases in skeletal muscle index and lean mass (p < 0.001), but exercise stifled losses in muscle strength and transition into sarcopenic. Behavioral and psychological symptoms of dementia and activities of daily living approached significance (p = 0.06) with positive trends observed across other psychosocial measures. This study demonstrates the value of exercise participation, and specifically aquatic exercise in comparison to usual care for older, institutionalized adults with advanced dementia. However, it also highlights a number of barriers to participation. To overcome these barriers and ensure opportunity to residents increased provider and sector support is required.

Feasibility and benefits of group-based exercise in residential aged care adults: a pilot study for the GrACE programme.

The objective of the study was to examine the feasibility and benefits of a group resistance training exercise programme for improving muscle function in institutionalised older adults. A feasibility and acceptability study was designed for a residential aged care (RAC) facility, based on the Gold Coast, Australia. Thirty-seven adults, mean age 86.8 ± 6.1 years (30 females) living in a RAC facility. Participants were allocated into an exercise (n = 20) or control (n = 17) group. The exercise group, the Group Aged Care Exercise (GrACE) programme, performed 12 weeks of twice weekly resistance exercises. Feasibility was measured via recruitment rate, measurement (physiological and surveys) completion rate, loss-to-follow-up, exercise session adherence, adverse events, and ratings of burden and acceptability. Muscle function was assessed using gait speed, sit-to-stand and handgrip strength assessments. All intervention participants completed pre- and post-assessments, and the exercise intervention, with 85% (n = 17) of the group attending ≥ 18 of the 24 sessions and 15% (n = 3) attending all sessions. Acceptability was 100% with exercise participants, and staff who had been involved with the programme strongly agreed that the participants “Benefited from the programme.” There were no adverse events reported by any participants during the exercise sessions. When compared to the control group, the exercise group experienced significant improvements in gait speed (F(4.078) = 8.265, p = 0.007), sit to stand performance (F(3.24) = 11.033, p = 0.002) and handgrip strength (F(3.697) = 26.359, p < 0.001). Resistance training via the GrACE programme is feasible, safe and significantly improves gait speed, sit-to-stand performance and handgrip strength in RAC adults.

Does residential aged care need dental professionals? A qualitative study on dental professionals' perceptions in Australia.

Adults in residential aged care often retain their own teeth following restorative dental procedures during their lives. They may also have physical and psychological comorbidities impacting on oral health including side effects from medications. residents' poor oral hygiene, dental caries and periodontal disease raise questions about the quality of oral health care in aged care facilities. This paper presents findings from a study investigating dental professionals' perceptions of barriers and enablers to providing oral care to residents in such settings. Following university ethics approval, semi-structured interviews were conducted with 17 dental professionals [five dentists, three oral health therapists (OHTs) and nine dental hygienists] across Australia to address the issue. Interviews were transcribed and analysed for key themes, noting similarities and differences within and between groups that were compared to existing evidence. Key themes emerging from interviews included individual and organisational difficulties dental professionals experience when meeting residents' oral health needs; poor access to dental resources; limited oral health education for aged care staff; and lack of interprofessional collaboration. Suggested enablers to oral health included interprofessional education and practice, reflecting broader trends in health care that positively impact on health outcomes. Improving residents' oral health requires appropriate organisational commitment to support dental and non-dental health providers deliver high-quality oral care. This study highlights the need to critically review barriers and enablers to providing such care, particularly as Australia's ageing population increases and longer periods are spent in residential aged care.

Prevalence and risk factors of sarcopenia among adults living in nursing homes

ObjectivesSarcopenia is a progressive loss of skeletal muscle and muscle function, with significant health and disability consequences for older adults. We aimed to evaluate the prevalence and risk factors of sarcopenia among older residential aged care adults using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Study designA cross-sectional study design that assessed older people (n=102, mean age 84.5±8.2 years) residing in 11 long-term nursing homes in Australia. Main outcome measurementsSarcopenia was diagnosed from assessments of skeletal mass index by bioelectrical impedance analysis, muscle strength by handheld dynamometer, and physical performance by the 2.4m habitual walking speed test. Secondary variables where collected to inform a risk factor analysis. ResultsForty one (40.2%) participants were diagnosed as sarcopenic, 38 (95%) of whom were categorized as having severe sarcopenia. Univariate logistic regression found that body mass index (BMI) (Odds ratio (OR)=0.86; 95% confidence interval (CI) 0.78–0.94), low physical performance (OR=0.83; 95% CI 0.69–1.00), nutritional status (OR=0.19; 95% CI 0.05–0.68) and sitting time (OR=1.18; 95% CI 1.00–1.39) were predictive of sarcopenia. With multivariate logistic regression, only low BMI (OR=0.80; 95% CI 0.65–0.97) remained predictive. ConclusionsThe prevalence of sarcopenia among older residential aged care adults is very high. In addition, low BMI is a predictive of sarcopenia.

Objectively measured activity patterns among adults in residential aged care.

Objectives: To determine the feasibility of using the activPAL3TM activity monitor, and, to describe the activity patterns of residential aged care residents. Design: Cross-sectional. Setting: Randomly selected aged care facilities within 100 km of the Gold Coast, Queensland, Australia. Participants: Ambulatory, older (≥60 years) residential aged care adults without cognitive impairment. Measurements: Feasibility was assessed by consent rate, sleep/wear diary completion, and through interviews with staff/participants. Activity patterns (sitting/lying, standing, and stepping) were measured via activPAL3TM monitors worn continuously for seven days. Times spent in each activity were described and then compared across days of the week and hours of the day using linear mixed models. Results: Consent rate was 48% (n = 41). Activity patterns are described for the 31 participants (mean age 84.2 years) who provided at least one day of valid monitor data. In total, 14 (45%) completed the sleep/wear diary. Participants spent a median (interquartile range) of 12.4 (1.7) h sitting/lying (with 73% of this accumulated in unbroken bouts of ≥30 min), 1.9 (1.3) h standing, and 21.4 (36.7) min stepping during their monitored waking hours per day. Activity did not vary significantly by day of the week (p ≥ 0.05); stepping showed significant hourly variation (p = 0.018). Conclusions: Older adults in residential aged care were consistently highly sedentary. Feasibility considerations for objective activity monitoring identified for this population include poor diary completion and lost monitors.

Spiritual Care: Recognizing Spiritual Needs of Older Adults

SUMMARY This paper explores aspects of spiritual needs and assessment, while emphasizing the importance of aged care providers being spiritually self-aware. The context of this exploration is meaning in life, spirituality and quality of life as experienced by older adults. Depression and dementia are frequently seen among older adults in residential aged care with resultant lowered quality of life. Pastoral and spiritual care may be used effectively to help alleviate depression and support older people who have dementia. However, to be able to provide appropriate spiritual care, spiritual needs should be assessed. Ways of assessing spiritual needs are suggested.

The Effectiveness of Music and/or Massage on Satisfaction, Wellbeing and Quality of Life Indicators for Lucid Older Adults in Residential Aged Care

Objectives The overall objective of this review is to determine the best available evidence regarding the effectiveness of music and/or massage on quality of life, wellbeing and satisfaction indicators for lucid older adults (those aged 70 years or older, or 50 years or older for indigenous adults) in residential aged care. Question Is music and/or massage effective on quality of life, wellbeing and satisfaction indicators for lucid older adults in residential aged care? Criteria for considering studies for the review Participants These will include all older adults not diagnosed with dementia, in a residential aged care setting. It will include acute and chronic behaviours of concern (not including altered mental states). Older adults are defined as aged 70 years or over, or aged 50 years or over for indigenous residents (as stated by the Australian Government’s Australian Institute of Health and Welfare, 2004). Residents who are aged younger than 70 years (or 50 years for indigenous residents), and those with the specific altered mental states such as confusion, dementia or agitation are excluded from the review. Interventions Music therapy (both receptive and active therapy will be included): The following categories will be included: • Quiet, • Popular, • Relaxing, • Stimulating, or • Individually preferred music. Played either to, or by, groups or individuals. Massage therapy: Massage therapies without aromatherapies carried out by a qualified therapist, including: • Massage with or without plain carrier oils • Partial or full body massage For the purposes of this review, massage therapies are required to include physical soft tissue manipulation, thus excluding touch therapies such as therapeutic touch, acupressure and reflexology, unless some element of manipulative massage was also clearly included. Aromatherapy is defined as the use of essential oils, papers including aromatherapy will be included provided the data related to massage can be extracted and analysed separately. Aromatherapy is not included in this review. Outcome Measures • Satisfaction – any personal or group measures of satisfaction, measured by validated scales, classifications and measurement systems. • Quality of life – any measure of quality of life utilising the following definition TRUNCATED AT 350 WORDS