Life In Long-Term Care Research Articles

Activity, Activity Personalization, and Well-Being in Nursing Home Residents With and Without Cognitive Impairment: An Integrative Review

ABSTRACT Objectives: Engagement in personally relevant and pleasant activity is a facet of many theories of well-being. This integrated review and narrative synthesis explored the hypothesis that activity participation improves well-being for nursing home residents. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, PsycINFO, Academic Search Complete, Psychology and Behavioral Sciences Collection, Embase, and CINAHL for research published between 2006 and 2018. We included peer-reviewed, English-language studies of nursing-home residents, with interventions focused on activities and on well-being or affect outcomes. Results: After screening, the search yielded 45 studies: 15 reviews of specific activities and 30 empirical articles. We found consistent support for tailored activity interventions and less consistent support for specific or generic activity interventions with the possible exception of music therapy. Research focused on specific activity types had methodological limitations and confounds with activity preferences. Conclusions: Participation in activities may improve well-being in residents of nursing homes. Tailored activities are likely to be superior to those provided indiscriminately to all residents. Clinical Implications: Improving quality of life in long-term care should include opportunities to engage in activities; those most effective will be tailored to individuals and no single activity will be effective for everyone.

Effect of a Structured Exercise Program in Reducing Falls and Improving Balance and Gait in the Elderly Population Living in Long-Term Care Homes – A Randomized Controlled Trial

Effect of a Structured Exercise Program in Reducing Falls and Improving Balance and Gait in the Elderly Population Living in Long-Term Care Homes – A Randomized Controlled Trial

Team-Based Integrated Knowledge Translation for Enhancing Quality of Life in Long-term Care Settings: A Multi-method, Multi-sectoral Research Design.

Multi-sectoral, interdisciplinary health research is increasingly recognizing integrated knowledge translation (iKT) as essential. It is characterized by diverse research partnerships, and iterative knowledge engagement, translation processes and democratized knowledge production. This paper reviews the methodological complexity and decision-making of a large iKT project called Seniors - Adding Life to Years (SALTY), designed to generate evidence to improve late life in long-term care (LTC) settings across Canada. We discuss our approach to iKT by reviewing iterative processes of team development and knowledge engagement within the LTC sector. We conclude with a brief discussion of the important opportunities, challenges, and implications these processes have for LTC research, and the sector more broadly.

THE USE OF SPECIALIST HEALTH CARE IN NURSING HOMES AS AN INDICATOR FOR QUALITY OF CARE

Needs-based medical care is essential for maintaining and promoting health and quality of life in long-term care. But still knowledge of medical needs and of needs-based medical care of nursing home (NH) residents is limited. However, individual studies, primarily based on secondary data, show that NH residents have significantly less contact with specialists than community-dwelling elderly. The aim of the study is therefore to gain knowledge about medical needs of NH residents as well as about the use of (specialist) medical care especially with respect to vision, hearing and oral health. Besides sociodemographic and care-related data we evaluated health status and utilization of medical care by means of standardized assessments for n=500 NH-residents. Results show that there are inequalities in (specialist) medical care: More experienced knowledge about unmet medical care needs will be used to generate ideas on how to improve the provision of medical care in nursing homes.

Slow-Stream Expiratory Muscle Strength Training for Veterans With Dysphagia Living in Long-term Care

Slow-Stream Expiratory Muscle Strength Training for Veterans With Dysphagia Living in Long-term Care

Screening for Vision Impairments in Individuals with Dementia Living in Long-Term Care: A Scoping Review.

Vision impairments are prevalent, but underdiagnosed in individuals with dementia living in long-term care (LTC). Effective screening tools could identify remediable vision problems. This scoping review was conducted to identify vision screening tests used with individuals with dementia and assesses their suitability for administration by nurses in LTC. A literature search using the Arksey and O’Malley (2005) method included research articles, conference proceedings, and dissertations. Data were included from participants over 65 years of age with a diagnosis of probable dementia. A panel of vision experts evaluated the suitability of the candidate vision tests. The search yielded 179 publications that met the inclusion criteria. Of 134 vision tests that were identified, 19 were deemed suitable for screening by nurses in LTC. Tests screened for acuity (12), visual field (1), anatomy (2), color vision (2), and general visual abilities (2). Tests were excluded because of complexity of interpretation (90), need for specialized training (83), use in research only (57), need for specialized equipment (54), not assessing visual function (44), long test duration (21), uncommonness (13), and needing an act reserved for specialists (7). Psychometric properties were not often reported for tests. Few of the tests identified had been validated for use with individuals with dementia. Based on our review, few tests were deemed suitable for use by nurses to assess this population in LTC. Identifying appropriate tools to screen vision in individuals with dementia is a necessary first step to interventions that could potentially improve functioning and quality of life.

Cognitive Stimulation for Individuals with Parkinson's Disease Dementia Living in Long-Term Care: Preliminary Data from a Randomized Crossover Pilot Study.

Background While the efficacy of cognitive stimulation (CS) has been demonstrated in patients with dementia, no study has included patients with Parkinson's disease dementia (PDD). Objective For the first time, this randomized crossover pilot study examined the feasibility and potential effects of CS in PDD. Methods All residents of a PDD-specific long-term care unit in the Netherlands that were eligible for the study (n=12) were randomly allocated to group A (n=6) receiving CS (eight weeks, twice weekly for 60 minutes) or group B (n=6) receiving usual care (control group, CG). The CG participated in CS afterwards, resulting in an experimental group (EG), consisting of n=12. Pre- and postassessments and a six-week follow-up (FU) were conducted for cognition, neuropsychiatric symptoms, quality of life (QoL), and activities of daily living (ADL) outcomes. Results Between-group analysis with difference scores from pre- to posttest revealed a group difference for global cognition (CERAD total score) favoring the EG, with a moderate effect size and a p value just failing to reach statistical significance (p=0.067; r = 0.43). A further statistical trend was observed for neuropsychiatric symptoms, again with a moderate effect size (p=0.075; r = 0.42). Within-group analyses indicated improvement only in the EG with large effects also just failing to reach significance for global cognition (short term, p=0.060; r = 0.70) as well as for depression (long term, p=0.072; r = 0.61). ADL deteriorated significantly at FU in the EG (p=0.014; r = 0.71). Conclusions Although our data are preliminary due to the small sample size, this study shows that CS is feasible and potentially effective for cognitive and noncognitive outcomes in PDD patients. Randomized controlled trials with larger sample sizes are needed to confirm these promising results.

ISQUA18-2303Every Voice Counts: A Community Engagement Approach to Understanding Life in Long Term Care from the Perspective of Every Resident Living in Publicly Funded Seniors Care Homes in British Columbia Cda.

ISQUA18-2303Every Voice Counts: A Community Engagement Approach to Understanding Life in Long Term Care from the Perspective of Every Resident Living in Publicly Funded Seniors Care Homes in British Columbia Cda.

Prevalence of Loneliness, Anxiety, and Depression among Older People Living in Long-Term Care: A Review

Objective: The aim of this paper was to review prevalence rates of loneliness, anxiety, and depression among older people living in long-term care settings such as residential aged care facilities, nursing homes and assisted living facilities. Method: A systematic search of the literature was conducted using several electronic databases including Medline, CINAHL, PsycINFO, and the Cochrane library. Results: In total, 18 articles met the inclusion criteria for this review. The results indicated that the prevalence rates of loneliness (56% to 95.5%), anxiety (3.6% to 38%), and depression (11% to 85.5%) in older people living in long-term care settings are generally high. Conclusion: Further research on effective methods of reducing these symptoms is recommended.

Family care conferences in long-term care: Exploring content and processes in end-of-life communication.

A total of 24 FCCs were held for residents with a Palliative Performance Scale score of 40% (nearing death). Data were collected from conference forms (i.e., Family Questionnaires, Care Plan Conference Summaries), site-specific electronic chart documents, and fieldnotes. Directed content analysis of data was informed by the Canadian Hospice Palliative Care Association's Square of Care Model, which describes eight domains of care: disease management, physical, psychological, social, practical, spiritual, EoL, and loss/bereavement. The FCCs addressed an average of 71% of the content domains, with physical and EoL care addressed most frequently and loss/bereavement addressed the least. Two goals and five interventions were documented and planned on average per FCC. Examination of the processes supporting EoL communication found: (1) advantages to using FCC forms versus electronic charts; and (2) high levels of multidisciplinary participation overall but limited participation of personal support workers (PSWs) and physicians. Communication around the end of life in LTC can be supported through the use of FCCs. Description of content and FCC processes provides guidance to persons implementing FCCs. Recommendations for tailoring conferences to optimize communication include use of specific conference forms, increased bereavement discussion, and further engagement of PSWs and physicians.

Renovations Big and Small Can Help Make the SNF More Like Home

Renovations Big and Small Can Help Make the SNF More Like Home

Correction: Correction: Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country.

Correction: Correction: Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country.

Correction: Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country.

[This corrects the article DOI: 10.1371/journal.pone.0161705.].

Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country.

BackgroundThere have been fundamental shifts in the attitude towards, access to and nature of long term care in high income countries. The proportion and profile of the older population living in such settings varies according to social, cultural, and economic characteristics as well as governmental policies. Changes in the profiles of people in different settings are important for policy makers and care providers. Although details will differ, how change occurs across time is important to all, including lower and middle income countries developing policies themselves. Here change is examined across two decades in England.Methods and FindingsUsing the two Cognitive Function and Ageing Studies (CFAS I: 77% response, CFAS II: 56% response), two population based studies of older people carried out in the same areas conducted two decades apart, the study diagnosis of dementia using the Automated Geriatric Examination for Computer Assisted Taxonomy, health and wellbeing were examined, focusing on long term care. The proportion of individuals with three or more health conditions increased for everyone living in long term care between CFAS I (47.6%, 95% CI: 42.3–53.1) and CFAS II (62.7%, 95% CI: 54.8–70.0) and was consistently higher in those without dementia compared to those with dementia in both studies. Functional impairment measured by activities of daily living increased in assisted living facilities from 48% (95% CI: 44%-52%) to 67% (95% CI: 62%-71%).ConclusionsHealth profiles of residents in long term care have changed dramatically over time. Dementia prevalence and reporting multiple health conditions have increased. Receiving care in the community puts pressure on unpaid carers and formal services; these results have implications for policies about supporting people at home as well as for service provision within long term care including quality of care, health management, cost, and the development of a skilled, caring, and informed workforce.

The social organization of a sedentary life for residents in long-term care.

Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC.

“We Get to Decide”: The Role of Collective Engagement in Counteracting Feelings of Confinement and Lack of Autonomy in Residential Care

Maintenance of well-being is recognized as important for well-being in residential care, but the particular contribution that social groups and group activities make in this context is rarely considered. To understand how we can foster well-being in care, this study explores (a) older adults’ general experiences of life in long-term residential care and (b) their particular experiences of participation in this group intervention. Ten semi-structured interviews were conducted with long-term care home residents and interview transcripts were analyzed thematically. Thematic analysis revealed two overriding themes that illustrated participants’ general experiences of life in care. The first theme, “care home as home,” suggests that adjustment and positive social relations with carers play a role in enhancing well-being. The second theme, “being stuck,” describes a general sense of confinement and a lack of control associated with living in long-term care. The significance of collective engagement became evident in relation to this second theme. Specifically, participants’ involvement in the group activity considered here was experienced as making a positive contribution to building social relations with other residents and, in doing so, as reducing residents’ sense of confinement and lack of control. Engagement in the group intervention and the resulting positive social relationships were thus experienced as a means of counteracting participants’ sense of being stuck. Overall, the findings point to the importance of group activities in fostering older adults’ autonomy and control—and thus well-being—in care.

Measuring End-of-Life Care and Outcomes in Residential Care/Assisted Living and Nursing Homes

ContextThe two primary residential options for older adults who require supportive care are nursing homes and residential care/assisted living. More than one-quarter of all deaths in the U.S. occur in these settings. Although the information available on end of life in long-term care has been growing, the comparative suitability of various measures to guide this work is unknown. ObjectivesTo determine the optimal measures to assess end-of-life care and outcomes in nursing homes and residential care/assisted living. MethodsA total of 264 family members of decedents from 118 settings were interviewed and provided data on 11 instruments that have been used in, but not necessarily developed for, long-term care populations; Overall, 20 scales and subscales/indices were evaluated. Measures were compared on their psychometric properties and the extent to which they discriminated among important resident, family, and setting characteristics. ResultsPrioritizing measures that distinguish the assessment of care from the assessment of dying, and secondarily that exhibit an acceptable factor structure, this study recommends two measures of care—the Family Perceptions of Physician—Family Caregiver Communication and the End of Life in Dementia (EOLD)-Satisfaction With Care—and two measures of outcomes—the EOLD-Symptom Management and the EOLD-Comfort Assessment in Dying. An additional measure to assess outcomes is the Mini-Suffering State Examination (MSSE). The care measures and the MSSE are especially valuable as they discriminate between decedents who were and were not transferred immediately before death, an important outcome, and whether the family expected the death, a useful target for intervention. ConclusionDespite these recommendations, measurement selection should be informed not only on the basis of psychometric properties but also by specific clinical and research needs. The data in this manuscript will help researchers, clinicians, and administrators understand the implications of choosing various measures for their work.

Resident- and Facility-Level Predictors of Quality of Life in Long-Term Care

Although there is substantial research on quality of care in nursing homes (NH), less is known about what contributes to quality of life (QOL) for NH residents. This study assesses multiple domains of QOL and examines facility- and resident-level correlates for different domains. Data come from (a) self-reported resident interviews using a multidimensional measure of QOL; (b) resident clinical data from the Minimum Data Set; and (c) facility-level characteristics from Minnesota Department of Human Services. We used factor analysis to confirm domains of QOL, and then employed cross-sectional hierarchical linear modeling to identify significant resident- and facility-level predictors of each domain. We examined six unique domains of QOL: environment, personal attention, food, engagement, negative mood, and positive mood. In multilevel models, resident-level characteristics were more reliable correlates of QOL than facility characteristics. Among resident characteristics, gender, age, marital status, activities of daily living, mood disorders, cognitive limitations, and length of stay consistently predicted QOL domains. Among facility characteristics, size, staff hours, quality of care, and percent of residents on Medicaid predicted multiple QOL domains. Examining separate domains rather than a single summary score makes associations with predictors more accurate. Resident characteristics account for the majority of variability in resident QOL. Helping residents maintain functional abilities, and providing an engaging social environment may be particularly important in improving QOL.

Sit, breathe, smile: Effects of single and weekly seated Qigong on blood pressure and quality of life in long-term care

Long-term care (LTC) facilities house individuals with diverse combinations of cognitive and physical impairments, and the practice of Seated Qigong eliminates common exercise barriers. This study hypothesized: 1) a single session would lower blood pressure (BP) and improve quality of life (QOL) in a generalized LTC population, and 2) these responses would be attenuated with chronic (weekly) Seated Qigong practice. Ten residents (6 female; 86 ± 7 years) participated in 1X/week Seated Qigong sessions for 10-weeks. BP and QOL were assessed pre- and post-session at baseline and following 5- and 10-weeks of Qigong. Systolic BP was significantly reduced immediately post-session after 10-weeks of Qigong (P = 0.03), yet unchanged at baseline and after 5-weeks (all P > 0.05). Diastolic BP and QOL remained unchanged (P > 0.05). A session of Seated Qigong elicits a hypotensive response with exposure, supporting the notion that repeated sessions may provide advantageous health benefits.

The Art of Change: Quality of Life in Long-Term Care

The Art of Change: Quality of Life in Long-Term Care