Home-like Environment Research Articles

Challenges, Opportunities, and Innovations in the Health and Well-being of the World’s Aging Citizens

Challenges, Opportunities, and Innovations in the Health and Well-being of the World’s Aging Citizens

Systematic Review Looking at the Use of Technology to Measure Free-Living Symptom and Activity Outcomes in Parkinson's Disease in the Home or a Home-like Environment.

Background:The emergence of new technologies measuring outcomes in Parkinson’s disease (PD) to complement the existing clinical rating scales has introduced the possibility of measurement occurring in patients’ own homes whilst they freely live and carry out normal day-to-day activities.Objective:This systematic review seeks to provide an overview of what technology is being used to test which outcomes in PD from free-living participant activity in the setting of the home environment. Additionally, this review seeks to form an impression of the nature of validation and clinimetric testing carried out on the technological device(s) being used.Methods:Five databases (Medline, Embase, PsycInfo, Cochrane and Web of Science) were systematically searched for papers dating from 2000. Study eligibility criteria included: adults with a PD diagnosis; the use of technology; the setting of a home or home-like environment; outcomes measuring any motor and non-motor aspect relevant to PD, as well as activities of daily living; unrestricted/unscripted activities undertaken by participants.Results:65 studies were selected for data extraction. There were wide varieties of participant sample sizes (<10 up to hundreds) and study durations (<2 weeks up to a year). The metrics evaluated by technology, largely using inertial measurement units in wearable devices, included gait, tremor, physical activity, bradykinesia, dyskinesia and motor fluctuations, posture, falls, typing, sleep and activities of daily living.Conclusions:Home-based free-living testing in PD is being conducted by multiple groups with diverse approaches, focussing mainly on motor symptoms and sleep.

Environmental Enrichment in Postoperative Pain and Surgical Care

Holistic biopsychosocial care has been underemphasized in perioperative pathway designs. The importance and a cost-effective way of implementing biopsychosocial care to improve postoperative pain and facilitate surgical convalescence are not well established, despite the recent popularization of Enhanced Recovery After Surgery (ERAS) programs. We have explored the evidence and rationale of environmental enrichment (EE) as a complementary multimodal psychosocial care pathway to reduce postoperative pain, optimize patient recovery and improve existing weaknesses in surgical care. We conducted a database search to identify and grade potential EE techniques for their evidence quality and consistency in the management of acute postoperative pain, perioperative anxiety and the etiologically comparable acute procedural or experimental pain. The introduction of music, virtual reality, educational information, mobile apps, or elements of nature into the healthcare environment can likely improve patients' experience of surgery. Compared with traditional psychological interventions, EE modalities are voluntary, therapist-sparing and more economically sustainable. We have also discussed practical strategies to integrate EE within the perioperative workflow. Through a combination of sensory, motor, social and cognitive modalities, EE is an easily implementable patient-centered approach to alleviate pain and anxiety in surgical patients, create a more homelike recovery environment and improve quality of life.

At Home in a Psychiatric Hospital

People who have mental illness are in particular need of what a home can provide, but they are especially vulnerable to not being in a place with a home-like environment, whether due to homelessness, incarceration, or hospitalization. At any given time, approximately 170,000 people are inpatients in psychiatric units or hospitals (NASMHPD 2017). Psychiatric hospitals are not homes, and they are not designed for long-term stay. The main purpose of the modern psychiatric hospital is to stabilize people in mental health crises, such as those who are psychotic or suicidal; hospitals are best thought of as temporary, transitional dwellings. Even though a person may only reside there for a week or a month, however, it is a crucial period of stabilization and healing. As this paper argues, practices of home-making increase epistemic and moral agency, which enables crisis stabilization, healing, and recovery. This paper examines several functions of home and shows some of the ways that patients in psychiatric hospitals try to replicate these functions in the physical space they have given their many constraints. Because practices of home-making support the goals of hospitalization, the hospital experience should be designed to encourage these practices as much as possible.

Building semantic grid maps for domestic robot navigation

This article proposes a semantic grid mapping method for domestic robot navigation. Occupancy grid maps are sufficient for mobile robots to complete point-to-point navigation tasks in 2-D small-scale environments. However, when used in the real domestic scene, grid maps are lack of semantic information for end users to specify navigation tasks conveniently. Semantic grid maps, enhancing the occupancy grid map with the semantics of objects and rooms, endowing the robots with the capacity of robust navigation skills and human-friendly operation modes, are thus proposed to overcome this limitation. In our method, an object semantic grid map is built with low-cost sonar and binocular stereovision sensors by correctly fusing the occupancy grid map and object point clouds. Topological spaces of each object are defined to make robots autonomously select navigation destinations. Based on the domestic common sense of the relationship between rooms and objects, topological segmentation is used to get room semantics. Our method is evaluated in a real homelike environment, and the results show that the generated map is at a satisfactory precision and feasible for a domestic mobile robot to complete navigation tasks commanded in natural language with a high success rate.

Freestanding Midwife-Led Units: A Narrative Review.

Background:Strengthening of midwives' position and support for freestanding birth centers, frequently referred to as Freestanding Midwife-led Units (FMUs), raise hopes for a return to humanized labor. Our study aimed to review published evidence regarding FMUs to systematize the knowledge of their functioning and to identify potential gaps in this matter.Materials and Methods:A structured integrative review of theoretical papers and empirical studies was conducted. The literature search included MEDLINE, Cochrane, Scopus, and Embase databases. The analysis included papers published in 1977–2017. Relevant documents were identified using various combinations of search terms and standard Boolean operators. The search included titles, abstracts, and keywords. Additional records were found through a manual search of reference lists from extracted papers.Results:Overall, 56 out of 107 originally found articles were identified as eligible for the review. Based on the critical analysis of published data, six groups of research problems were identified and discussed, namely, 1) specifics of FMUs, 2) costs of perinatal care at FMUs, 3) FMUs as a place for midwife education, 4) FMUs from midwives' perspective, 5) perinatal, maternal, and neonatal outcomes, and 6) FMUs from the perspective of a pregnant woman.Conclusions:FMUs offers a home-like environment and complex midwifery support for women with uncomplicated pregnancies. Although emergency equipment is available as needed, FMU birth is considered a natural spontaneous process. Midwives' supervision over low-risk labors may provide many benefits, primarily related to lower medicalization and fewer medical interventions than in a hospital setting.

Application of Behavioural Emotional Rating scale (BERS 2nd ed.) to Study Social and Emotional Behaviour of Students at Middle Level in District Mirpur Azad Jammu Kashmir

Social Emotional Learning (SEL) is an ‘Umbrella term’ which covers all the aspects of development of an individual and can increase positive attitude towards self and others, hence reduces negative thinking. Social Emotional Learning is necessary to provide awareness to develop five core competencies i. Self-Awareness, ii. Self-Management, iii. Relationship skills, iv. Social-Awareness, v. Responsible decision making in students, as it is prerequisite for learning process. It creates a stable person who knows, how to behave in certain circumstances. The objectives of the study were to analyze the self-management in students at Middle level, identify the factors associated with responsible decision making, to develop better relationship skills that associates confidence in children, to explore the social awareness rate, to examine the abilities of children self-awareness. This study was quantitative in nature as it was implementation of BERS Scale (2nd Ed.) which is accurate &amp; valid scale to measure attitude &amp; is based on 4-point Likert Scale. Data was collected through BERS Questionnaires which are authentic and comprises of 55 questions. Data was analyzed trough applying of statistical techniques. Results showed majority of the students said that they are stable which indicate that Education system in Mirpur (A.J.K) has been improved in the past few years due to teacher training programs and facilities provided to the students. The study recommended that Social Emotional learning is essential for students. It also suggested that students can be saved from getting into depression, anxiety, regression, aggression and other mental disorders trough proper parental care, eradication of poverty, teacher training, gifted &amp; talented education (GATE) of teachers and turning of schools into homelike environment.

A Pilot Study of an In-Home Multicomponent Exergame Training for Older Adults: Feasibility, Usability and Pre-Post Evaluation.

Aging is associated with sensory, motor and cognitive impairments that may lead to reduced daily life functioning including gait disturbances, falls, injuries and mobility restrictions. A strong need exists for implementing effective evidence-based interventions for healthy aging. Therefore, the aim of this study was to (i) evaluate the feasibility and usability of an in-home multicomponent exergame training and (ii) explore its effects on physical functions, cognition and cortical activity. Twenty-one healthy and independently living older adults were included (11 female, 74.4 ± 7.0 years, range: 65–92 years) and performed 24 trainings sessions (each 40 min) over eight weeks. The first part was conducted in a living lab (home-like laboratory environment), the second part at participants’ home. The multicomponent exergame included Tai Chi-inspired exercises, dance movements and step-based cognitive games to train strength, balance and cognition. Attendance and attrition rates were calculated and safety during training was evaluated to determine feasibility. Participants rated the usability of the exergame (System Usability Scale) and reported on their game experience (Game Experience Questionnaire). Physical and cognitive functions and cortical activity (resting state electroencephalopathy) were assessed pre and post intervention. Results showed a high training attendance rate for the living lab and the home-based setting (91.7 and 91.0%, respectively) with a rather high attrition rate (28.6%, six drop-outs). Half of the drop-out reasons were related to personal or health issues. System usability was rated acceptable with a mean score of 70.6/100. Affective game experience was rated favorable. Significant improvements were found for minimal toe clearance, short-term attentional span, and information processing speed (p < 0.05). No significant pre-post differences were found for cortical activity. To summarize, the exergame is generally feasible and usable for healthy older adults applied in an in-home setting and provides an overall positive emotional game experience. Nevertheless, flawless technical functionality should be a mandatory consideration. Additionally, the training might have potential positive influence on specific functions in older adults. However, the efficacy has to be evaluated in a future randomized controlled trial assessing the behavioral and neuroplastic changes in a larger population after a longer training period.

NURSING ASSISTANTS’ OPINIONS ON CREATING THE PERFECT DINING EXPERIENCE FOR RESIDENTS WITH DEMENTIA

Feeding residents with dementia in long-term care settings can be challenging, partly related to environmental factors. Certified Nursing Assistants (CNAs) are primarily responsible for feeding residents with dementia who need assistance. Given that older adults with dementia have an increased risk of developing malnutrition, there is a need to develop standards in place for constructing an ideal dining environment to optimize residents’ dietary intake. This qualitative study was conducted to explore CNA’s perspectives of how dining areas could be enhanced to improve food intake of residents with dementia. Nine focus groups were conducted with a total of 53 CNAs who had at least one year of experience feeding residents. Focus groups were audio recorded and transcribed verbatim. Data were analyzed using directed content analysis guided by the Social Ecological Model. CNAs reported that distractions can significantly inhibit residents’ food intake; therefore, limiting distractions such as noise and crowding is important. CNAs also reported the benefit of playing music in the dining area depended on the individual resident. Additionally, CNAs emphasized the importance of offering a variety of appetizing menu choices tailored to residents’ preferences. CNAs have firsthand experience with residents with dementia and can provide valuable insights. Long-term care administration should consider interdisciplinary support to improve the mealtime experience of residents with dementia in an effort to enhance their dietary intake. In particular, providing a variety of menu choices in a well-lit, calm, spacious, and homelike dining environment can be beneficial.

REFLECTIONS FROM HOMELAB: DEVELOPING TASKS TO MEASURE UPPER-BODY FUNCTION IN A SIMULATED HOME

Homelike research spaces provide a unique context for studying older adulthood by blurring the boundaries between the participant’s own home and traditional laboratories. Such intermediary spaces hold promise for developing measures of functional performance with increased ecological validity. While “home labs” are becoming more accessible at institutions around the world, the research design process in these spaces contains hidden challenges that can be a barrier to entry for the uninitiated. We identify and reflect on these challenges through the lens of a recent protocol built to assess upper-body performance among older adults during activities of daily living. The U-M HomeLab served as a proving ground for four example tasks: opening a water bottle, sorting pills, tying an apron, and hanging laundry. The evolution of each task is traced through ideation, testing, and refinement, culminating in a pilot among nine community-dwelling volunteers aged 61 to 72 with upper-body pain. Based on this experience, we recommend that designers of naturalistic tasks in homelike environments give special consideration to (1) feasibility, (2) scorability, and (3) safety while carefully balancing standardization against verisimilitude. In turn, each of these elements must be grounded not only in the context of the facility itself but also in the population using that facility. Among older adults with upper body pain, considerations included remaining cognizant of fall risk, anticipating and capturing compensatory behaviors, tailoring task difficulty for a wide range of physical ability, and accounting for the impact of historically gendered divisions of labor on task performance.

Resident and staff perspectives of person-centered climate in nursing homes: a cross-sectional study

BackgroundPerson-centered care is widely recognized as a gold standard and is based on a supportive psychosocial climate for both residents and staff in nursing homes. Residents and staff may have different perspectives as to whether the climate in which they interact is person-centered, perhaps due to their different expectations of the nursing home environment and the provision of care services. The aim of this study was to explore and compare resident and staff perspectives of person-centered climate in aged care nursing homes.MethodsThis is a descriptive cross-sectional study using a cluster random sampling method. The study collected data in 2016 from residents (n = 251) and nursing staff (n = 249) in 23 nursing homes using a Person-centered Climate Questionnaire-Patient version and Person-centered Climate-Staff version. T-tests for independent-samples were used to compare scores ranked by nursing staff and residents.ResultsThe mean scores of ‘A climate of safety’ subscale and ‘A climate of everydayness’ subscale rated by residents were significantly lower than those rated by nursing staff. The mean scores of ‘A climate of hospitality’ rated by residents were very low among the three subscales, an indicator of the need to improve a more home-like environment for residents. Residents in larger size nursing homes showed a higher score of person-centered climate compared with their counterparts in small size nursing homes.ConclusionsThis study reveals that the perspectives and perceptions of person-centered climate differ between residents and nursing staff. Therefore, both resident and staff perspectives should be taken into account in attempting to improve person-centered climate for better care outcomes.

CN24 - Hospice care, what to expect? An exploration of the expectation of future hospice patients

BackgroundHospice care aims to optimize the quality of life of patients and their families in the last phase of life by diminishing physical, psychological, social and spiritual suffering. Expectations are associated with patient satisfaction. A theoretical framework was used, distinguishing expectations with respect to process, structure and outcomes. The aim of the study is to explore expectations of hospice care of future hospice patients. MethodsA generic qualitative study was performed from January to July 2018. Eleven patients with a life expectancy <1 year (‘surprise question’) were enrolled. In addition, two patient advocates were included to gain a broader view on expectations. Semi structured interviews were transcribed verbatim, analyzed by 2 researchers independently and results were discussed in the research team. ResultsThe participants covered a range in gender, age, spiritual beliefs, living area, primary diagnosis, phase of palliation and knowledge on the topic. Participants expect to be admitted to hospice when death was imminent and dying at home becomes impossible. They expect a homelike environment and the ability to continue living like being at home. Participants are sure that caregivers in hospice care are loving and trustworthy. Without doubt patients expect them to provide appropriate care and treatment with the skills and knowledge necessary. ConclusionsHospices have the responsibility to ensure nuanced and balanced information on hospice care in the Dutch society to set realistic expectations. Information about the possibilities and aims of hospice care, including short stay admissions, respite care and support at home in collaboration with primary caregivers should be widespread to ensure timely and appropriate hospice care for all patients in need. Legal entity responsible for the studyThe authors. FundingZonMw. DisclosureAll authors have declared no conflicts of interest.

Promoting mental health in out of home care in Australia.

Young people in out of home care (OoHC) typically have worse mental health outcomes than peers who grow up within a family of origin. Innovations to improve the mental health of this group have tended to focus on pathology rather than mental health promotion and prevention of mental illnesses, and are often costly and challenging to implement. This qualitative study explored perspectives from young people with experience of OoHC in Melbourne, Australia regarding the promotion of mental health in OoHC. The study informed the subsequent development of a system-level intervention to support workers and carers in OoHC and evaluation of its implementation, the Ripple study. We conducted thematic analysis of data from interviews and focus groups with 14 young people aged 18-24 years with diverse identities and experiences of foster, kinship and residential care. We identified four key themes. These were providing a home-like environment; having someone to talk to; connecting to the wider community and having opportunities to become an active citizen. There is a need for both mental health promotion and treatment approaches in interventions to support workers and carers and young people in OoHC. Mental health promotion strategies should include a focus on enhancing existing capacities of carers and workers. Mental health promotion for young people in OoHC depends on strong intersectoral collaboration and youth participation.

Barriers to women's access to alongside midwifery units in England

BackgroundAlongside midwifery units (AMUs) are managed by midwives and proximate to obstetric units (OUs), offering a home-like birth environment for women with straightforward pregnancies. They support physiological birth, with fast access to medical care if needed. AMUs have good perinatal outcomes and lower rates of interventions than OUs. In England, uptake remains lower than potential use, despite recent changes in policy to support their use. This article reports on experiences of access from a broader study that investigated AMU organisation and care. MethodsOrganisational case studies in four National Health Service (NHS) Trusts in England, selected for variation geographically and in features of their midwifery units. Fieldwork (December 2011 to October 2012) included observations (>100 h); semi-structured interviews with staff, managers and stakeholders (n = 89) and with postnatal women and partners (n = 47), on which this paper reports. Data were analysed thematically using NVivo10 software. ResultsWomen, partners and families felt welcome and valued in the AMU. They were drawn to the AMUs’ environment, philosophy and approach to technology, including pain management. Access for some was hindered by inconsistent information about the existence, environment and safety of AMUs, and barriers to admission in early labour. ConclusionsKey barriers to AMUs arise through inequitable information and challenges with admission in early labour. Most women still give birth in obstetric units and despite increases in the numbers of women birthing on AMUs since 2010, addressing these barriers will be essential to future scale-up.

Stopping the "revolving door": "Zeida Laderech," a unique rehabilitation house for young adults with severe and enduring eating disorders.

Afailure to maintain improvement achieved during acute treatment, followed by a "revolving door syndrome," is a common phenomenon in eating disorders (EDs). As a result, many patients develop a chronic course that is difficult to treat. To target these difficulties, we established a novel rehabilitation treatment model in Israel for patients with severe and enduring EDs, based on the "recovery theory" in mental health treatment. This paper describes the process of conceiving this model and specifies the components of this rehabilitation house, "Zeida Laderech" (Provisions for the Journey), that aims to provide a home-like environment, while assisting in developing a healthy and balanced lifestyle. Finally, the model is discussed in light of other residential programs established in the world. With the hope to improve the overall prognosis of individuals with EDs, it is suggested that the similar programs and ongoing innovation will continue to emerge internationally.

Organizational factors of fall injuries among residents within German nursing homes: secondary analyses of cross-sectional data.

The present study explored risk factors for fall injuries among nursing home residents, with a specific focus on the influence of organizational structure within facilities and their environment, which have been insufficiently investigated in the European context. For the analyses, secondary data collected in 2016 from 220 nursing homes across Germany were used. As a risk adjustment, two separate models were calculated for fall injuries among residents without (N = 7320) and with cognitive impairment (N = 8633). Results showed that residents without cognitive impairment had a decreased risk of fall injuries by 40.1% (P < 0.01), while those with cognitive impairment were at an increased risk of 23.8% (P < 0.05) when living in facilities that had dementia care units. However, disparities were found between federal states for both groups of residents (P < 0.05 vs. P < 0.01, respectively). Similarly, a higher proportion of registered nurses were associated with decreased risk of fall injuries among cognitively impaired residents (45.6%), which differed between federal states (P < 0.01). Facilities with homelike environments had a 16.7% (P < 0.05) lower risk of fallinjuries among cognitively impaired residents than did traditionally organized facilities. Further research is needed to explain the disparities between German federal states using representative samples.

Researching, Planning, and the Implementation of Tāłtān Language Nests: Sharing our Experiences

Since 2012, our nation has been working to revitalize and reclaim our language, with an emphasis on the creation of new speakers. Tahltan Elders have spoken about the importance of our young children learning our language, so a focus has been on teaching babies and toddlers in language nests. A language nest is a home-like environment for infants to learn the language in an immersion setting and provides opportunities for all generations to be part of the revitalization of a language. One of the authors carried out research that focused on Tahltan community experiences of language revitalization. The investigation focused on language revitalization’s connection to health and healing and what needs to be done to revitalize our language. Following recommendations from that research, language nests have been one of the vital components our Language and Culture Program has focused on. The ways in which community members in Tahltan communities have planned and implemented language nests will be discussed, along withe sharing experiences and activities that are currently being carried out.

「家庭的」であることと児童養育責任 今日的「社会的養育」としての児童福祉施策の枠組み検討

「家庭的」であることと児童養育責任 今日的「社会的養育」としての児童福祉施策の枠組み検討

Perceptions of home in long-term care settings: before and after institutional relocation

AbstractAlthough moving from institutional to home-like long-term care (LTC) settings can promote and sustain the health and wellbeing of older adults, there has been little research examining how home is perceived by older adults when moving between care settings. A qualitative study was conducted over a two-year period during the relocation of residents and staff from an institutional LTC home to a purpose-built LTC home in Western Canada. The study explored perceptions of home amongst residents, family members and staff. Accordingly, 210 semi-structured interviews were conducted at five time-points with 35 residents, 23 family members and 81 staff. Thematic analyses generated four superordinate themes that are suggestive of how to create and enhance a sense of home in LTC settings: (a) physical environment features; (b) privacy and personalisation; (c) autonomy, choice and flexibility; and (d) connectedness and togetherness. The findings reveal that the physical environment features are foundational for the emergence of social and personal meanings associated with a sense of home, and highlight the impact of care practices on the sense of home when the workplace becomes a home. In addition, tension that arises between providing care and creating a home-like environment in LTC settings is discussed.

“They give you back that dignity”: understanding the intangible resources that make a transitional house a home for homeless families

ABSTRACTApproximately 33% of the homeless population in 2017 were families with children. Researchers have argued for interventions and services to employ an ecological perspective to mitigate some of the unintentional harm inherent in existing programs designed to serve homeless families. This paper utilized a case study of a transitional housing program to (1) determine how well the program met recommendations informed by the ecological perspective and (2) explore underlying themes across recommendations. Past and current residents of a transitional housing program participated in semi-structured interviews as part of a program evaluation. Interviews were deductively and inductively coded to meet aims 1 and 2, respectively. Residents identified several aspects of the program that met the ecological perspective recommendations including culturally-responsive services, trauma-based services, and social and community connections. Major underlying themes spanning across recommendations included interpersonal resources (caring, sense of belonging), empowerment resources (advocacy, family preservation), impact on family (family life, positive youth development), and communication. This case study, through the analysis of residents’ perspectives, highlights the important role of transitional housing programs in providing a supportive, empathetic, empowering, and home-like environment that gives residents “back that dignity” so they are emotionally and physically prepared to successfully transition to permanent housing.