Non-pharmacological Interventions For Older Adults Research Articles

Constipation among Korean older adults in long-term care facilities: A scoping review

Purpose: This study synthesized the literature on constipation among Korean older adults in long-term care (LTC) facilities. Methods: This scoping review utilized the Joanna Briggs Institute protocol. We conducted a literature search using Cumulative Index to Nursing and Allied Health, PubMed, PsycINFO, Korean databases Research Information Sharing Service, Korean Studies Information Service System, and ScienceON. Two reviewers independently selected the studies and extracted their characteristics using pretested forms to determine the final inclusion. In total, 473 articles were identified, and eight were used for the final analysis. Results: Quasi-experimental design was the most common research design. Sex, age, state of mobility, admission periods, LTC classification, sleep satisfaction, depressive symptoms, diet type, daily fluid intake, and history of digestion were identified as factors related to constipation. The most widely used constipation measurement method is measuring the frequency of defecation per week. Massage is the most commonly used nursing intervention to relieve constipation. Conclusion: The diversification of research on constipation is necessary to improve the quality of life of older adults living in LTC facilities. Therefore, the use of reliable tools to determine constipation in older adults in LTC facilities should be expanded. There is a need to develop and implement diverse non-pharmacological interventions for older adults in LTC facilities. The results of this study are intended to serve as a basis for the development of constipation programs for Korean older adults in LTC facilities.

How COVID-19 Ceases All Older Adult Services & the Way Out for Community-Dwelling Older Adults with Chronic Pain

The COVID-19 pandemic started at the beginning of 2020. It significantly impacted the older adults in Hong Kong, with most of the community centers and elderly centers being closed down under various restrictive measures. Thus, community-based health promotion activities were temporarily paused, which decreased older adults’ health-promoting behaviors and motivation to stay active. This research aimed to improve the quality of life and the health of older adults with chronic pain through the pain management program. This study was conducted face-to-face on the campus of Hong Kong Metropolitan University. This dyadic pain management program (DPM) was an 8-week group-based program. The DPM comprised 4 weeks of campus-based activities and 4 weeks of digital-based activities delivered via a WhatsApp group. An 80% participation rate in the campus-based activities was regarded as completing the DPM. The control group only received lesson leaflets. Pain intensity, pain self-efficacy, psychological health of pain victims, caregiver burden inventory, and a semi-structured interview were evaluated at week 1 (T0), week 8 (T1), and week 12 (T2) after randomization. The IBM-SPSS version 22 was used to perform statistical analyses. Using non-pharmacological methods and regular exercise for 12 weeks improved physical health in terms of pain intensity, pain self-efficacy, and psychological health in anxiety, depression, and stress. For caregivers, their burden decreased after the pain management program. These findings indicated that Pender’s Health Promotion Model is helpful to empower the participants and their caregivers with knowledge, skills, and power to manage their chronic pain situations. Utilizing this model as a framework, Researchers can design more effective non-pharmacological interventions for older adults to increase their engagement in health-promoting activities in the community.

Non-pharmacological interventions for cognitive impairment in older adults with heart failure: A systematic review

BackgroundCognitive impairment is a prevalent issue among older adults with heart failure, and non-pharmacological approaches are recommended as the first line of treatment. However, it remains unclear which non-pharmacological interventions are the most effective for achieving optimal cognitive and physical outcomes. The aim of this study is to summarize the available evidence on the impact of non-pharmacological interventions for optimizing cognitive function in older adults with HF. MethodsA systematic research was carried out across multiple databases including PubMed, Embase, Scopus, Web of Science, PsycINFO, Cochrane Library, Chinese National Knowledge Infrastructure Database, and Wanfang Database up until May 2022. Randomized controlled trials that focused on non-pharmacological interventions for older adults with heart failure and cognitive impairment, and evaluated the impact on cognitive function were targeted. The risk bias of the selected articles was analyzed following the Cochrane handbook. Two independent reviewers were responsible for selecting the studies, extracting the data, and assessing their quality. The results were reported in a narrative format. ResultsA total of 11 studies, which involved 1,287 patients, were reviewed and showed an acceptable risk of bias. These studies evaluated various cognitive domains, including global cognition, delayed recall memory, working memory, and verbal memory. Non-pharmacological interventions that included cognitive intervention, cognitive training combined with exercise, exercise training, and self-care management, were shown to have a positive impact on cognitive function, physical performance, and depression levels in older adults with heart failure. One study explored the effects of electrical muscle stimulation therapy, but no significant improvement in cognitive abilities was observed. ConclusionThe available evidence for the effectiveness of non-pharmacological interventions for cognitive impairment in older adults with heart failure is limited, and further research with formal outcome measures and longer follow-up periods is necessary to provide more informed recommendations.

Correlates of Adherence of Multimodal Non-pharmacological Interventions in Older Adults With Mild Cognitive Impairment: A Cross-Sectional Study.

BackgroundNon-pharmacological interventions are promising for delaying cognitive decline in older adults with mild cognitive impairment (MCI). Although some studies have demonstrated adherence rates and factors influencing participation in single modality non-pharmacological interventions, little is known about the level and correlates of adherence to multimodal non-pharmacological interventions (MNPIs) in older adults with MCI.ObjectiveThis study aimed to explore the adherence level and the correlates of adherence to MNPIs in older adults with MCI.MethodsA cross-sectional design was employed. Community-dwelling older adults aged 60 years and over were recruited from senior community centers and healthcare centers in Huzhou from March 2019 to December 2020. Data were collected by a general information questionnaire and the adherence scale of cognitive dysfunction management (AS-CDM) in older adults with MCI. Hierarchical regression analyses were applied to explore the correlates of adherence to MNPIs.ResultsA total of 216 completed questionnaires were finally analyzed. Of these, 68.52% were female, and 45.4% of the participants had no less than 6 years of education. The overall mean score for adherence was 117.58 (SD = 10.51) out of 160, equivalent to 73.49 in the hundred-mark system, indicating a medium-level adherence to MNPIs in older adults with MCI. Of the five dimensions of adherence (AS-CDM), self-efficacy scored the highest, and the lowest was perceived barriers. The univariate analysis showed that the factors associated with the adherence to MNPIs were: regular physical exercise, meat-vegetable balance, absence of multimorbidity, high level of education, living alone, and living in urban (p < 0.05). In the hierarchical regression analysis, the final model explained 18.8% of variance in overall adherence (p < 0.01), which high school (Beta = 0.161, p < 0.05), college and above more (Beta = 0.171, p < 0.05), meat-vegetarian balance (Beta = 0.228, p < 0.05), regular physical exercise (Beta = 0.234, p < 0.05), and presence of multimorbidity (Beta = −0.128, p < 0.05) significantly contributed to adherence. In addition, nearly 80% of older adults with MCI preferred MNPIs.ConclusionEarly assessment and management of adherence to MNPIs were essential in older adults with MCI. Furthermore, the findings shed light on several critical areas of intervention to improve adherence to MNPIs in older adults with MCI.Clinical Trial Registrationhttp://www.chictr.org.cn/showproj.aspx?proj=35363, ChiCTR1900020950 (Registered on January 23, 2019).

Perceived Benefits of Using Nonpharmacological Interventions in Older Adults With Alzheimer's Disease or Dementia With Lewy Bodies.

The current qualitative research explored perceived effects of three nonpharmacological interventions (chair yoga [CY], participatory music intervention [MI], and chair-based exercise [CBE]) in managing symptoms in older adults with Alzheimer's disease or dementia with Lewy bodies from family caregivers' perspectives. Three focus groups were conducted following completion of the 12-week interventions. Constant comparative analysis determined whether each intervention had perceived effects on symptoms, based on caregivers' perspectives. Three major themes emerged: (a) Changes in Cognitive Symptoms, (b) Changes in Physical Function, and (c) Changes in Mood, Behavioral Symptoms, and Sleep Disturbance. Results can be integrated into treatment plans for older adults with dementia. Future research should focus on CY or CBE with support from caregivers to manage dementia symptoms and compare CY or CBE practiced with caregivers against CBE or CY practiced solely by participants with dementia. [Journal of Gerontological Nursing, 46(1), 37-46.].

COMPARATIVE EFFECTIVENESS OF CANINE- OR EQUINE-ASSISTED THERAPY FOR RESIDENTS WITH DEMENTIA

Older adults with dementia may manifest symptoms such as apathy, withdrawal, and aggressive actions (NIA, 2019). Even surrounded by people in LTC, residents with dementia may lack social engagement. Non-pharmacologic approaches are promising (Brodaty & Arasaratnam, 2012) and are reflected in the newer CMS F-tag guidelines (CMS, 2017), but there remains a gap in research about the most effective approaches for LTC residents. Limited research exists on animal-assisted interventions (AAI) as a non-pharmacological approach to increase engagement in people with dementia (Friedman, Thomas & Chung, 2015; Huff-Mercer, 2015) and no known research compares equine- and canine-assisted therapy protocols. This study employed a within-subject alternating-treatments design for three single subjects. Completing the similar tasks of grooming, walking, and interaction, the independent variables are two conditions: 1) Condition A: Equine-assisted activity 2) Condition B: Canine-assisted activity. Using the Dementia Interview Rating (Strauss & Sperry, 2002), apathy was measured before and after each phase. During each session, three outcomes were measured: 1) Engagement in Preferred Activities Scale (Nelson et al., 2014) was used to measure the level of engagement in the interaction; 2) Heart rate variability, a measure of coherence, was measured using the Emwave pro (Heart Math Institute, 2018), and 3) targeted observed social responsiveness (initiation, verbal response, non-verbal response, motor response to one-step instructions) using a smart tablet application. Preliminary results suggest past experience/preference impact the individual client’s response to differing protocols. Effective non-pharmacological interventions for older adults with dementia are an essential alternative to current practice.

Feasibility of Conducting Nonpharmacological Interventions to Manage Dementia Symptoms in Community-Dwelling Older Adults: A Cluster Randomized Controlled Trial.

This study assessed the feasibility of conducting 3 nonpharmacological interventions with older adults in dementia, exploring the effects of chair yoga (CY), compared to music intervention (MI) and chair-based exercise (CBE) in this population. Using a cluster randomized controlled trial (RCT), 3 community sites were randomly assigned 1:1:1 to CY, MI, or CBE. Participants attended twice-weekly 45-minute sessions for 12 weeks. Thirty-one participants were enrolled; 27 safely completed the interventions and final data collection (retention rate of 87%). Linear mixed modeling was performed to examine baseline and longitudinal group differences. The CY group improved significantly in quality of life compared to the MI group (CY mean = 35.6, standard deviation [SD] = 3.8; MI mean = 29.9, SD = 5.3, P = .010). However, no significant group differences were observed in physical function, behavioral, or psychological symptoms (eg, for mini-PPT: slopetime = 0.01, standard error [SE] = 0.3, P = .984 in the CBE group; slopetime = -0.1, SE = 0.3, P = .869 in the MI group; slopetime = -0.3, SE = 0.3, P = .361 in the CY group) over the 12-week intervention period. Overall, this pilot study is notable as the first cluster RCT of a range of nonpharmacological interventions to examine the feasibility of such interventions in older adults, most with moderate-to-severe dementia. Future clinical trials should be conducted to examine the effects of nonpharmacological interventions for older adults with dementia on health outcomes.

Nonpharmacological Interventions for Anxiety and Dementia in Nursing Homes: A Systematic Review.

Anxiety is a major mental disorder in later life that impacts on activities of daily living and quality of life for adults living with dementia in nursing homes. The aim of this article was to systematically review nonpharmacological interventions for older adults living in nursing homes who experience comorbid anxiety and dementia.MethodA systematic literature search was conducted across key databases (Cinahl, ASSIA, Cochrane reviews and trials, psycARTICLES, psycINFO, and PubMed) to identify studies measuring anxiety as an outcome for an intervention for older adults living with dementia in nursing homes, up to December 31, 2017.ResultsThe search yielded a total of 1,925 articles with 45 articles accessed for full article review. A total of 13 articles were included in this review following quality appraisal based on Cochrane methodology with six different anxiety measures used. The studies included were moderate to high-quality randomized control trials although heterogeneity precluded a combined meta-analysis.Clinical implicationsThe most common interventions used to address anxiety in this population were music therapy and activity-based interventions although there was limited evidence for the efficacy of either intervention. Little is known about effective nonpharmacological treatment for anxiety for people living with dementia in nursing homes. Further research using consistent measurement tools and time points is required to identify effective interventions to improve the quality of life for people living with both dementia and anxiety in nursing homes.

Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis.

To review the effectiveness of non-pharmacological interventions in older adults with depression or anxiety and comorbidities affecting functioning. Systematic review and meta-analysis of randomized controlled trials, including searches of 10 databases (inception-Jul 2017). Home/community. People aged 60 and over experiencing functional difficulties from physical or cognitive comorbidities and have symptoms or a diagnosis of depression and/or anxiety. Non-pharmacological interventions targeted at depression/anxiety. We extracted outcome data on depressive symptoms, quality of life, functioning, and service use. We used random effects meta-analysis to pool study data where possible. Two authors assessed the risk of bias using the Cochrane Risk of Bias tool. We identified 14 eligible trials including 2099 randomized participants and two subgroup analyses. Problem-solving therapy (PST) reduced short-term clinician-rated depressive symptoms (n=5 trials, mean difference in Hamilton Depression Rating Scale score -4.94 [95% CI -7.90 to -1.98]) but not remission, with limited evidence for effects on functioning and quality of life. There was limited high-quality evidence for other intervention types. Collaborative care did not appear to affect depressive symptoms, functioning, or quality of life; and had mixed evidence for effects upon remission. No intervention consistently affected service use, but trials were limited by small sample sizes and short follow-up periods. No anxiety interventions were identified. PST may reduce depressive symptoms post-intervention in older people with depression and functional impairments. Collaborative care appears to have few effects in this population. Future research needs to assess cost-effectiveness, long-term outcomes, and anxiety interventions for this population.

Effects of health education in the elderly with mild cognitive impairment.

to analyze the effects of health education on both cognition and depressive/anxiety symptoms in the elderly with Mild Cognitive Impairment (MCI). this is a randomized and controlled clinical trial. Participants (n=22) were recruited from a specialized outpatient clinic, and assigned into two groups: a Health Education Group (HEG) (n=10) and a Control Group (CG) (n=12). The participants were evaluated before and after the intervention, which was composed of classes and dynamics. The intervention consisted of 20 meetings, over a period of five months. The assessment was performed by means of the Addenbrooke's Cognitive Examination - Revised (ACER), the Mini-Mental State Examination to access participant's cognitive state, and the Beck's Scale to access depressive/anxiety symptoms. A Memory Complaints Scale (EQM) was also used. The analysis was carried out using the Student's t test for paired samples. the HEG group demonstrated an improvement in attention/orientation (p= 0,026), memory (p=0.001), language (p= 0.033), and ACE-R (p= 0.003). On the other hand, the CG did not present improvement. the results highlight the importance of non-pharmacological interventions in older adults with MCI to reduce cognitive deficits.

The effectiveness of nonpharmacological interventions in older adults with depressive disorders: a systematic review.

It is widely acknowledged that mental disorders are common in old age and that depression is one of the most serious threats to the mental health of older adults. The lives of older adults are adversely affected both by major depression and subsyndromal depression. Depression should be approached with both pharmacotherapy and complementary therapies. The disadvantages posed by psychopharmacotherapy may be more prominent among older adults and there is a greater probability of drug interference. Different nonpharmacological interventions have been reported to reduce depressive symptoms in older adults with no adverse side effects. This review aimed to identify and synthesize the best available evidence on the effectiveness of nonpharmacological interventions for older adults with depressive disorders. This review considered studies that included older adults: adult patients, aged over 65 years with any type of depressive disorder, regardless of comorbidities and any previous treatments, but excluded those with manic or psychotic episodes/symptoms. Patients receiving pharmacological treatment for depression or other illnesses were included. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: This review considered studies that used nonpharmacological interventions for older adults with depressive disorders. TYPES OF STUDIES: This review considered any experimental study design, including randomized controlled trials, non-randomized controlled trials, or other quasi-experimental studies, including before and after studies. TYPES OF OUTCOMES: This review considered studies that included the following outcome measures: depressive symptomatology. The secondary outcomes were the level of autonomy in activities of daily living, cognitive function, health-related quality of life and wellbeing. An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies from January 2000 to March 2012 of major healthcare-related electronic databases. Studies in English, Spanish and Portuguese were included in the review. Methodological quality was assessed by two independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Two independent reviewers assessed 23 studies. There was general agreement among the reviewers to include six of the studies in this review. Data were extracted using the Joanna Briggs Institute data extraction form for experimental studies and included participant characteristics, intervention characteristics and methods of the study. The impact of interventions on depression outcomes was described in a narrative format for each specific intervention. Data from two studies were pooled in a meta-analysis. Twenty-three studies met the inclusion criteria. Of those, 17 studies were excluded after assessment of their methodological quality. The remaining six original articles, which included 520 participants, were included in this review. Five were randomized clinical trials and one was a quasi-experimental study. The interventions included in this systematic review were: cognitive behavior therapy, competitive memory training, reminiscence group therapy, problem-adaptation therapy, and problem-solving therapy in home care. Evidence suggests that all of these interventions reduce depressive symptoms. Data from two studies reporting the effectiveness of problem-solving therapy in home care were pooled in a meta-analysis. The meta-analysis showed homogeneity (heterogeneity Chi-squared=2.83, p=0.09). The analysis estimated a statistically significant reduction (z= 11.19; p< 0.0001) of -10.23 points (CI: -12.03, -8.44) in the 17-item Hamilton Depression Rating Scale (HAM-D-17). Evidence suggests that all of these interventions reduce depressive symptoms and, therefore, may be useful in practice. However, due to the diversity of interventions and the low number of studies per intervention included in this systematic review, evidence is not strong enough to produce a best practice guideline.

The effectiveness of nonpharmacological interventions in older adults with depressive disorders: a systematic review

The effectiveness of nonpharmacological interventions in older adults with depressive disorders: a systematic review

The Effects of Exercise, Cognitive Intervention and Combined Exercise and Cognitive Intervention in Alder Adults with Cognitive Impairment and Alzheimer’s Disease

Cognitive impairment is a defining feature of dementia caused by neurodegenerative conditions such as Alzheimer’s disease (AD) and cerebrovascular disease. The combination of different protective factors of healthy cognitive aging might be most promising when attempting to delay cognitive decline and preserve cognitive abilities. Particularly, the combination of cognitive and physical activity has attracted increasing interest. But there is no review on the effects of exercise, cognitive intervention, and combined exercise and cognitive intervention in patients with cognitive impairment and AD and it is not cleared what is the best therapeutic intervention for these patients. 26 studies were identified in this review, most studies assessed general cognitive state such as MMSE or ADAS-Cog. Several studies indicated negative results included exercise, cognitive intervention, and combined exercise and cognitive intervention. Combination therapy may be plays an important role in enhancing cognitive function. The mechanisms of benefit from individual and combined physical and cognitive interventions are not clear, it has been postulated that physical and mental activity may therefore have potential to improve cognitive function. More research is needed to study the effect of combined non-pharmacological interventions in older adults with cognitive impairment.

Diversional and physical nonpharmacological interventions for behavioral and psychological symptoms of dementia.

This article is the last of a four-part series addressing the use of non-pharmacological interventions for older adults with behavioral and psychological symptoms of dementia (BPSD). These types of interventions are used to prevent, lessen, or eliminate BPSD, thereby reducing patient reliance on psychoactive medications. These interventions are easy to use, cost-effective, and simple to implement. The Centers for Medicare & Medicaid Services' psychoactive medication reduction initiative encourages all staff to use nonpharmacological interventions to manage BPSD. As with any attempt to handle BPSD, health care professionals and staff need a tool-box of interventions, as what works one day may not work the next and what works with one older adult may not work with another. This article describes the categories of diversional and physical nonpharmalogical interventions, presents the evidence supporting their use, and provides information on effective implementation.

The effectiveness of nonpharmacological nursing interventions in elderly with depressive disorders: a systematic review.

Review objective/questions The objective of this review is to identify and synthesise the best available evidence regarding the effectiveness of nonpharmacological nursing interventions for older adults with a depressive disorder. More specifically, the review will focus on the following questions: • Are nonpharmacological nursing interventions effective for reducing symptoms in older adults with depressive disorders? • Does the effectiveness of nursing interventions vary with the severity of symptoms? • Is the effectiveness of nursing interventions affected by the presence or absence of simultaneous pharmacological treatment? Inclusion Criteria Types of participants This review will consider studies that include elderly people: 1) adult patients, over 65 years old 2) with any type of depressive disorder, regardless of co-morbidities and any previous treatments, but will exclude those with manic or psychotic episodes/symptoms. 3) patients receiving pharmacological treatment for depression or for other illnesses will be included. Types of intervention(s) This review will consider studies that utilise nurse implemented nonpharmacological interventions for older adults with depressive disorders. These interventions may include, but not be limited to, music therapy, massage, reminiscence therapy, or physical exercise. Type of outcomes This review will consider studies that include the following outcome measures: depressive symptomatology, measured by any depression scale (such as the Geriatric Depression Scale), or change in severity of depressive symptoms, as assessed against diagnostic criteria (such as the ICD 10 or the DSM-IV-TR). The secondary outcomes will be level of autonomy in activities of daily living, cognitive function, health-related quality of life or well-being, measured by appropriate instruments (such as the Lawton-Brody Instrumental Activities of Daily Living Scale, Mini Mental State Examination, Montreal Cognitive Assessment, or the World Health Organization Quality of Life instrument WHOCOL-100). • How does the presence of comorbidities affect the effectiveness of nursing interventions for depressive disorders?

Cognitive training in older adults with Mild Cognitive Impairment: Impact on cognitive and functional performance.

Aging is associated with cognitive decline, yet this does not prevent older adults from finding ways to compensate for age-related deficits. Earlier studies have shown that cognitively unimpaired older adults can benefit from training programs. The efficacy of cognitive interventions among older adults without dementia but with cognitive decline (mild cognitive impairment, MCI) has not yet been widely tested.ObjectivesTo evaluate the impact of 8-session cognitive training on the cognitive and functional performance of older adults with MCI.Methods16 older adults diagnosed with MCI received cognitive training (18 participated as controls). All participants were assessed pre and post intervention using the Short Cognitive Test (SKT), Direct Assessment of Functional Scale Revised (DAFS-R), Geriatric Depression Scale (GDS), and Clock Drawing Test (CDT).ResultsA significant improvement was observed in the study group between pre and post-test in attention (SKT), time orientation, shopping skills and dealing with finances (DAFS-R) along with reduced depressive symptoms (GDS).ConclusionThese results indicate the importance of non-pharmacological interventions for older adults with MCI to help compensate for cognitive decline.