Older Adults In Residential Care Research Articles

'The burden is very much on yourself': A qualitative study to understand the illness and treatment burden of hearing loss across the life course.

Hearing loss is a chronic health condition that rises sharply with age. The way people respond to and cope with health conditions is influenced by their capacity to perform illness and treatment-related work. The aim was to explore the cumulative burdens of living with hearing loss and the resources mobilised to ease the burdens. A qualitative design was used with semi-structured interviews (online or in-person) with participants recruited through audiology services and nonclinical services, such as lip-reading classes. Forty-six participants with hearing loss aged between 16 and 96 years were interviewed. An abductive approach, informed by May et al.'s burden of treatment theory, was used to analyse the data. The illness burden involved participants working to make sense of their hearing loss, engaging in emotional work in response to changes in sound, social interactions and identity and coping with the daily frustrations required to communicate with others. Abandonment and uncertainty characterised the treatment burden; participants engaged in emotional work to adjust to hearing technology and deal with the uncertainty of how their hearing might progress. To ameliorate the burdens, participants drew on internal resources (psychological, health literacy, cognitive) and external resources (social support, financial, information, technology). The workload of hearing loss appears largely devolved to the patient and is not always visible. Our work indicates the need to widen approaches in audiological care through the implementation of lifeworld-led care, family-centred care and peer support to build support for those with hearing loss. We developed the project in consultation with members of the public who have lived experience of hearing loss recruited through Aston University and volunteer links to audiology services. We also consulted people more likely to be affected by hearing loss adults including adults with learning disabilities, older adults in residential care and people from South Asia (Bangladeshi, Indian and Pakistani communities). These individuals commented on the study aims, interview schedule and participant recruitment practices. One of our co-authors (expert by experience) contributed to the development and interpretation of themes and preparation of the final manuscript.

A mixed methods feasibility study of a virtual group-based social support program for older adults in residential care

Objectives In response to calls for inventive ways to mitigate risks of physical distancing due to the COVID-19 pandemic for older adults living in residential care, the JAVA Music Club–Digital (JMC-D) was developed. The current feasibility study investigated benefits, usability, and implementation of weekly JMC-D sessions over 6 months. Method Employing a pre-post mixed methods study, depressive symptoms, loneliness, social isolation, and quality of life were measured at baseline, 3 and 6 months. Qualitative interviews were conducted at 3 months. Results Twenty-one residents were recruited. Across the three time points there was a large effect for depressive symptoms, social isolation, and quality of life, though not statistically significant. There was a significant immediate increase in happiness following engagement in the JMC-D sessions. Thematic analysis of semi-structured interviews generated two overarching themes: Experiencing the JMC-D (subthemes: Benefits, Navigating the virtual platform, Feedback) and Considerations for Implementation (subthemes: Perceived purpose, Characteristics that impact the experience, and Infrastructure and resources). Conclusion Findings are encouraging and suggest that the JMC-D may support emotional and other psychosocial indices of wellness in residential care during times of physical distancing. Appropriate staffing, resources, and internet accessibility are important for implementation and uptake.

Effects of physical exercise on physical function in older adults in residential care: a systematic review and network meta-analysis of randomised controlled trials

Physical exercise is effective at attenuating ageing-related physical decline in general, but evidence of its benefits for older adults in residential care, who often have functional dependency, multimorbidity, and polypharmacy, is inconclusive. We aimed to establish the effects of exercise interventions on the physical function of this population. For this systematic review and network meta-analysis, we searched PubMed, Web of Science, Cochrane Library, Rehabilitation & Sports Medicine Source, and SPORTDiscus to identify randomised controlled trials assessing the effects of exercise interventions (vs usual care) on physical function (ie, functional independence, physical performance, and other related measures, such as muscle strength, balance, or flexibility) in adults aged 60 years or older living in residential care. Relevant studies published in English or Spanish up to Jan 12, 2023, were included in the systematic review. The quality of studies was assessed using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX) score. A network meta-analysis was performed for physical function-related outcomes reported in at least ten studies, with subanalyses for specific intervention (ie, exercise type, training volume, and study duration) and participant (eg, having cognitive impairment or dementia, pre-frail or frail status, and being functionally dependent) characteristics. The study protocol was registered on PROSPERO (CRD42021247809). 147 studies (11 609 participants, with mean ages ranging from 67 years [SD 9] to 92 years [2]) were included in the systematic review, and were rated as having overall good quality (median TESTEX score 9 [range 3-14]). In the meta-analysis (including 105 studies, n=7759 participants), exercise interventions were associated with significantly improved overall physical function, with a standardised mean difference [SMD] of 0·13 (95% credible interval [CrI] 0·04-0·21), which was confirmed in all analysed subpopulations. The strongest association was observed with 110-225 min per week of exercise, and the greatest improvements were observed with 170 min per week (SMD 0·36 [95% CrI 0·20-0·52]). No significant differences were found between exercise types. Subanalyses showed significant improvements for almost all analysed physical function-related outcomes (Barthel index, five-times sit-to-stand test, 30-s sit-to-stand test, knee extension, hand grip strength, bicep curl strength, Short Physical Performance Battery, 6-min walking test, walking speed, Berg balance scale, and sit-and-reach test). Large heterogeneity was found between and within studies in terms of population and intervention characteristics. Exercise interventions are associated with improved physical function in older adults in residential care, and should, therefore, be routinely promoted in long-term care facilities. None. For the Spanish translation of the abstract see Supplementary Materials section.

A Qualitative Study of the Usability and Likability of a Virtual Group-Based Social Support Program for Older Adults in Residential Care

ABSTRACT Objectives Despite social engagement being a robust predictor of wellbeing for older adults living in residential care, social programming ceased during the COVID-19 pandemic to abide by social distancing guidelines. Consequently, a tablet-based program called the Java Music Club-Digital (JMC-D) was developed. The JMC-D enables residents to engage with peers through discussion and singing from the safety of their own rooms. This study investigated the likability and usability of the JMC-D for older adults living in residential care and recreation staff. Methods Data was collected through semi-structured interviews and focus groups with seven residents and three recreation coordinators. Interviews were analyzed using thematic analysis. Results Three themes emerged: 1) Addressing a need, 2) Factors that affect virtual social connection, and 3) Usability. Interest in future participation in the JMC-D program varied depending on certain personal characteristics including comfort with computers, openness to new experiences, and existing social network. Conclusion Findings suggest that the JMC-D is likeable and usable for residents and recreation coordinators. Clinical implications Study findings can be applied by researchers and residential care staff who wish to increase the use of virtual social programs to improve the psychosocial health of residents. Constructive feedback was incorporated into the platform.

What quality of life domains are most important to older adults in residential care?

ABSTRACT Quality of life is a critically important outcome measure in aged care. However, few studies have provided a detailed examination of what quality of life means to older adults living in residential care. In the current study, N = 43 older adults (67 to 99 years) living in six residential aged care facilities in four Australian states took part in semi-structured interviews. Participants had normal cognition through to mild /moderate cognitive impairment as measured by the PAS-Cog, were able to provide informed consent, and could participate in an interview conducted in English. Interviews were transcribed, and data was analyzed in NVivo using thematic analysis. Both physical and psycho-social aspects were identified as important for older adults’ quality of life with six key quality of life domains identified: independence, mobility, pain management, social connections, emotional well-being, and activities. More research is needed to test these domains with a more diverse sample of older adults living in residential aged care, in particular older adults from culturally and linguistically diverse communities. Such qualitative work is essential for the development of suitable quality of life measures for this population and provides valuable information to inform improvements to care practices and service provision. Some ways in which the identified quality of life domains could be used to enhance care provision are discussed.

P04-11 A physical activity intervention designed to improve multi-dimensional health and functional capacity of frail older adults in residential care: a randomised controlled feasibility study

BackgroundFrailty is a common and clinically significant multi-dimensional syndrome associated with adverse health outcomes such as hospitalisation, disability, and mortality among older adults. Physical activity interventions have been shown to be effective in the prevention and treatment of functional decline and frailty, with strength training protocols reporting improvements in mobility, balance, preservation of muscle function and independence. Due to the trial's exploratory and feasibility design a small sample was used to investigate the acceptability and practicality in long term care. This includes addressing the HEPA priority of improving the health and well-being of people with chronic conditions and/or frailty.MethodsEleven older adults (aged >65 years) were randomised to the intervention or wait-list control. A 6-week strength training protocol for 35 mins 3x/week used resistance machines, specially designed for older adults, in a residential care home. Mixed methods were used to assess the feasibility and acceptability of the intervention and research measures and indicate meaningful differences in outcomes. Feasibility was measured through adherence statistics and focus groups/interviews with staff and participants. Pre- and post-intervention levels are given as descriptive statistics for physiological, psychosocial, cognitive, and functional measures. Intervention effect is illustrated through mean difference (95% Confidence Intervals) pre- to post-intervention in the intervention group.ResultsIntervention group (n = 6) adherence was 98.9%. Interviews revealed participants and staff found the measures and intervention acceptable, practicable and beneficial. Mean differences pre- to post-intervention indicated meaningful clinical difference in measures of strength, functional capacity and frailty. Psychosocial variables (stress, depression, social support), immunological measures, cognition and Activities of Daily Living Scores did not show meaningful change.ConclusionA strength training intervention protocol for frail care home residents was beneficial, with findings supporting a future randomised controlled trial. High adherence and clinically meaningful differences for frailty and physical function support the use of such interventions to improve multi-dimensional health, maintain functional capacity and independence, and enhance social participation in frail older adults. This study and further research may help inform practical physical activity initiatives for frail older adults, and support strategies prioritising health and well-being, and the prevention of functional decline and frailty.

Exploring older adult needs and preferences for technology-assisted group music-making. A qualitative analysis of data collected during the participatory user-centred design process

Purpose Engagement with arts, recreation and leisure is highly valued by older adults, with positive links to their continued wellbeing. Despite an availability of new music technology, these devices are rarely designed with older adults in mind. This project explores the needs and preferences of older adults in residential care as they interact with digital music interfaces in a group music-making context. Materials and methods Twenty participants at an Australian residential aged-care facility were involved in a user-centred design process (20 sessions across six months) to develop digital music interfaces suitable for group music-making. Participants’ verbal comments were audio-recorded and transcribed, supported by further written observation notes made by the activity facilitators. Results A hybrid inductive and deductive approach to thematic analysis revealed three main themes: individual music-making, ensemble music-making and social engagement. Our results suggest that when interfaces are designed with older adults in mind, technology-assisted group music-making can facilitate bringing together residents with different experiences and abilities. Conclusions These findings suggest implications for rehabilitation in developing a range of musical devices for older adults to account for required flexibility, whilst maintaining an appropriate and satisfyingly “rich” musical outcome. Implications for rehabilitation Older adults positively engage with music technology, showing distinct personal preferences for aspects of physical interaction, balance and quality of sound. Rehabilitation and/or wellbeing-based musical activities for older adults in residential care may benefit from considering tools that allow for personal adaptations such as these to be made. Preferences for musical interaction can be influenced by previous musical experiences, as well as physical and/or cognitive abilities. However, on any given day musical preferences can also be subject to change. Within a group music-making context, there is a significant capacity for older adults to feel agency in contributing to the overall sound; rehabilitation activities and/or technologies could be designed where this individual contribution to the group can be enhanced. Group music-making using new digital music interfaces has the potential to encourage interpersonal social connections that are most likely made over repeated sessions.

A Randomized Controlled Feasibility Trial Evaluating a Resistance Training Intervention With Frail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial.

Frailty is associated with negative health outcomes, disability, and mortality. Physical activity is an effective intervention to improve functional health status. However, the effect of resistance training on multidimensional health in frail older adults remains unclear. This randomized controlled trial was conducted in a U.K. residential care home to assess feasibility with limited efficacy testing on health and functional outcomes and to inform a future definitive randomized controlled trial. Eleven frail older adults (>65years) completed a 6-week machine-based resistance training protocol three times a week. Uptake and retention were greater than 80%. The measures and intervention were found to be acceptable and practicable. The analyses indicated large improvements in functional capacity, frailty, and strength in the intervention group compared with the controls. These findings support the feasibility of a definitive randomized controlled trial and reinforce the value of resistance training in this population. This trial was registered with ClinicalTrials.gov: NCT03141879.

Loneliness and boredom in residential care

OBJECTIVES: Older adults are more likely to experience loneliness and boredom in residential care. The purpose of this study is to extend the understanding of experiences of older adults in residential care and identify factors that residents believe contribute to loneliness and boredom. In addition, I aim to identify strategies used to cope with these experiences and provide recommendations to enhance the quality of life in residential care. METHODS: A phenomenological qualitative study was conducted through participant observation, in-depth interviews with 24 residents, and key informant interviews with 10 staff members. RESULTS: The findings emphasise the pervasiveness of loneliness and boredom despite facilities’ efforts to provide activities and support. Staff and family support helped to alleviate loneliness and boredom and participants employed individual coping strategies. DISCUSSION: Health professionals should recognise loneliness and boredom as issues in residential care and prioritise individual needs and preferences when designing activities.

Older Adults' Engagement in Residential Care: Pitfalls, Potentials, and the Role of ICTs.

Over the previous years, the residential care sector has gone through a transition from a rather paternalistic approach towards a more democratic way of caregiving. Nevertheless, many care organizations still find it challenging to engage their residents in the process of care. In this study, we investigated the challenges regarding the engagement of older adults in residential care. As recent studies indicated the increasing opportunities of ICTs, we paid particular attention to this in the process of engagement. We followed a participatory action research approach among caregivers and older adults at a somatic care department in a care residence in the Netherlands. Methods used included 15 participants in two homogeneous group sessions, reflections on action in practice, and one mixed focus group. Our findings show that both caregivers and older adults acknowledge the importance of engagement in daily care. However, their different perspectives on how this should take place, made the actual engagement of older adults a challenge. We determined three dilemmas complicating this engagement in care, and labeled these (1) autonomy versus dependence; (2) personal experiences versus privacy; and (3) happiness versus honesty. We found different ways of how caregivers and older adults deal with these dilemma’s in practice and defined these in terms of pitfalls and potentials. ICTs were shown to reinforce both the pitfalls and potentials. Paying attention to these challenges in residential care, including how caregivers and older adults deal with these challenges, will encourage a mutual understanding and actual engagement in decisions on daily care. Further research is recommended on the role of organizations’ management, older adults’ relatives, or older adults with cognitive impairments.

Animal Assisted Therapy for Older Adults in Aged Care Facilities: A Rapid Review

Purpose: Research has demonstrated the effectiveness of animal assisted therapy (AAT) for improving the mental health of older adults in residential care. The aim of this rapid review was to synthesise existing research evidence to determine the approaches that AAT should take to enhance outcomes for older adults living in residential care. Methods: A systematic literature search was conducted to identify studies published between 2009 and 2019 that investigated AAT and improvement in physical and/or psychosocial outcomes for adults aged over 65 years, living in residential care. Studies were critically appraised to determine methodological quality, key data were extracted, and a critical narrative synthesis was conducted to determine features of effective AAT intervention. Results: Eighteen studies were identified for inclusion in this review. All eligible studies utilised dogs for AAT. Nearly all studies found positive outcomes from the AAT; however, several features of AAT were associated with better outcomes. AAT was shown to be effective at improving depressive symptoms and socioemotional behaviours regardless of the frequencies, durations, and overall intervention periods employed. Participant quality of life only improved when AAT was conducted up to twice weekly. Physical interaction and combined physical interaction and walking were both associated with positive outcomes. The use of trained/certified therapy dogs was more likely to improve outcomes than using dogs with no reported training. Facilitators provided by AAT organisations, and facilitators with veterinary, nursing, or AAT training were associated with improved outcomes. Group AAT was associated with greater effectiveness than AAT conducted with individual participants. Studies where AAT was conducted in a combined indoor/outdoor or solely indoor setting appeared most likely to improve outcomes. Conclusion: AAT involving dogs was typically associated with positive outcomes for older adults living in residential care; however, some features of AAT were associated with better outcomes. To enhance outcomes, it is recommended that AAT be implemented in a group setting, include physical interaction or combined physical interaction, and walking, and be conducted by trained facilitators.

Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial

ObjectiveTo assess the antifracture efficacy and safety of a nutritional intervention in institutionalised older adults replete in vitamin D but with mean intakes of 600 mg/day calcium and <1 g/kg...

Cycling: how can we activate care-dependent older adults with a mild cognitive impairment?

Purpose In residential care, 50% of older adults are sedentary in most of their time, regardless of the positive impact of physical exercise on health. This study analysed whether television images positively impact the motivation and exercise intensity of cycling exercises of older adults in residential care. Methods In this randomised controlled cross-over study, 10 residential older adults (mean age 85.0 ± 5.7 years) with Mild Cognitive Impairment (MCI) participated in 3 different cycling exercise interventions (TV off, TV turned on the National Geographic channel (NG) and TV with MemoRide software (Activ84Health®, Leuven, Belgium) (MR) (cybercycling)) compared with a rest condition. Results The participants cycled significantly more distance during NG compared with TVoff (p = 0.024). In comparison to the rest condition, the mean heart rate was significantly higher in all exercise conditions while the maximal heart rate was only higher during NG (p = 0.022). There was no difference in the Borg scale between the different exercise interventions. Interest and enjoyment scored significantly higher during NG (p = 0.014) and MR (p = 0.047) compared to the rest condition and in the NG versus TVoff (p = 0.018). No significant differences were observed in the emotions of the participants. Conclusions This study has shown indications that the addition of television images may increase the exercise intensity and motivation to exercise in residential older adults with MCI. However, the overall levels of physical activity were insufficient to meet the recommendations for moderate-intense aerobic exercise according to the International Association of Gerontology and Geriatrics and Global Ageing Research Network. Implications for rehabilitation Cycling in front of a television increases the exercise volume and motivation to exercise in residential (pre)frail older adults with MCI Cybercycling had no additional effect in comparison to television images not linked to the exercise. Even with television images (pre)frail older adults with MCI did not meet the recommendations for moderate-intense aerobic exercise for residential older adults according to the IAGG-GARN.

Virtual tourism for older adults living in residential care: A mixed-methods study

Due to financial and mobility barriers, a majority of older adults living in collective dwellings are no longer able to engage in tourism, a leisure activity that contributes to quality of life and wellbeing. Immersive Virtual Reality (VR) may serve as a programmatic tool to facilitate tourism. This pilot study examined the effects of VR tourism exposure on indices of psychosocial wellbeing among older adults living in residential care. Using a mixed-methods study design, 18 older adults were exposed to VR tourism three times a week, over six weeks. Participants reported decreased anxiety and fatigue immediately following exposure, and increased social engagement and quality of life following six weeks of VR tourism. Qualitative data offered additional insight on the process by which VR tourism may enhance wellbeing. Findings suggest that immersive VR tourism may be a viable program for older adults in residential care.

New musical interfaces for older adults in residential care: assessing a user-centred design approach

Purpose:For older adults in aged-care, group music-making can bring numerous physical and psychological benefits, ultimately improving their quality of life. However, personalising music-making to optimise these benefits is often difficult given their diverse ages, experiences, abilities, cognitive and motor skills, and their experience with music technology. Materialsandmethods:In this study, we conducted a 10-week group music-making intervention with twenty participants in an aged-care home, using a prototype digital musical instrument that we iteratively refined by following a user-centred design approach from direct resident feedback. The prototype instrument adopted a novel method for errorless learning in music-making settings, which we also refined, by increasing the difficulty level of the instrument's operation. We also assessed the residents' engagement with the sessions by obtaining feedback from caregivers and facilitators. Results:Results show that residents' enjoyment decreased as the complexity (difficulty) of our errorless learning implementation increased. We also found that resident engagement increased when changes to the prototype digital musical instrument were provided, but not when residents were giving feedback. Results also found that participation over the course of the intervention, and the number of songs played during each session also enhanced engagement. Conclusions: Overall, our results show the intervention was beneficial to residents, although we note some areas of enhancement for further interventions in designing prototype musical instruments for group music-making in aged-care settings. IMPLICATIONS FOR REHABILITATION Older adults positively engage with novel music technology, and do so increasingly over subsequent sessions. Repeated sessions may have the potential to enhance longer-term adoption of technologies as well as any rehabilitative effects of the group music-making activity. There is significant potential for residents with different abilities to all make music together, although to maximise the sustainability of the devices, the sessions, and the subsequent rehabilitative benefits, residents must be given the right adaptation for individual interfaces that balances ambition and ability. Rapid DMI prototyping positively enhances engagement among older adults, suggesting that in the case of a custom DMI, an upgrade schedule should be aligned with key rehabilitative milestones. Similarly, in the case of pre-developed digital music systems, resident exposure to new features or functionality should be strategically introduced, so as to maximise engagement for key phases of resident rehabilitation.

Generation of thirst: a critical review of dehydration among older adults living in residential care

Dehydration is common among older adults and exacerbated in residential care. In this article, the authors summarise the reported prevalence of dehydration in this sub-population group and evaluate the associated risks before reviewing interventions designed to improve hydration. Heterogeneity in methods to assess dehydration inhibits interpretation of both prevalence and intervention studies (primarily small randomised control trials and case-control observational studies). The estimated prevalence of dehydration among older adults in residential care is 20-38%, with further increased prevalence of inadequate fluid intake, leading to increased urological, gastrointestinal, circulatory and neurological disorders or, in extreme cases, death. Multi-component interventions that include changes to drinks, vessels, placement and drinking opportunity, alongside staff training and support, are most effective in tackling dehydration in residential care. The detection and prevention of dehydration is crucial, and a practical, population-specific reference standard for adequate fluid intake is warranted. Future research should prioritise interventions that are individualised to residents' needs, according to dehydration typology. Ongoing investment in the care sector should address staff-to-resident ratios and enhance staff training on the detection and prevention of dehydration.

Older Adults’ Responses to a Meaningful Activity Using Indoor-Based Nature Experiences: Bird Tales

ABSTRACT Objectives Bird Tales is a meaningful activity that creates indoor-based nature experiences for older adults in residential care. This study examined the impact of Bird Tales by understanding what attributes of birds take on meaning to older adults and piloting the program to assess the psychosocial impact on older adults in an assisted living facility. Methods We conducted a mixed-methods study. First, we conducted focus groups with older adults. Then we used a cross-over study design with random assignment to examine the impact of the program. Potential benefits of the program were examined using individual interviews and repeated measures on psychosocial questionnaires with a paired samples t-test to compare means from pretest and posttest within the intervention group. Results Findings from the focus group indicate multisensory, spiritual, and therapeutic aspects of birds that hold meaning for older adults. The participants in Bird Tales shared positive experiences with the program by discussing cognitively stimulating activity, interactions with others, connections to the past, and positive perceptions of birds and nature. Conclusions Findings from our study suggest the potential of Bird Tales as a meaningful activity for older adults in residential care settings. We discuss implications for research as well as practice and present our recommendations. Clinical Implications Activities in long-term care should be meaningful to meet the psychological and social needs of older adults. Older adults enjoy and may benefit from indoor-based nature activities.

Occupational Therapy Interventions and Outcomes Measured in Residential Care: A Scoping Review

Aims: This scoping review identified the interventions and outcome measures used by occupational therapists working with older adults in residential care facilities.Methods: A five-step approach was used to retrieve and screen studies from five databases. Included studies described an occupational therapy intervention with older adults living in residential care facilities, were published in English, between 1990 and 2019 in a peer-reviewed publication. Data were mapped using domains of the Canadian Model of Occupational Performance and Engagement.Results: Findings from 51 studies revealed that occupational therapists most commonly implemented occupations as the intervention with little focus on aspects of the environment. Outcomes predominantly measured person factors and less commonly occupational performance and engagement.Conclusion: The exploration of the past foci of practice and measurement of therapeutic impact enables occupational therapists to consider how their practice can enhance future occupational performance and engagement of residential care facility residents.

Sources of well-being for older adults with and without dementia in residential care: relations to presence of meaning and life satisfaction

Objectives To explore what sources of well-being are rated meaningful by older adults in residential care and how they are related to two important well-being outcomes. Method Two cross-sectional questionnaire studies were conducted in a sample of care residents without cognitive disability (n = 329) and with Alzheimer’s disease (n = 104). Structural equation modelling was used to test a hypothesized and exploratory model of different sources as predictors of presence of meaning in life (POM) and satisfaction with life (SWL). Results Family and Health were rated most meaningful by residents with and without dementia. In both studies, the hypothesized model showed adequate fit with the data. For cognitively intact residents, Personal Growth, Spirituality/Religion, and Interpersonal Relationships predicted POM, while Family and Leisure predicted SWL. Exploratory testing identified Leisure as a possible additional predictor of POM. For residents with Alzheimer’s disease, Personal Growth and Society/Community predicted POM, while Family predicted SWL. Conclusion For older adults in residential care, many sources of well-being remain highly meaningful and some are directly related to the experience of meaning and life satisfaction. Both for residents with and without dementia, continued or increased investment in moments that foster personal growth and family relationships might be especially valuable.

Finding a Balance Between Integrity and Despair: A Challenging Task for Older Adults in Residential Care

Erikson described the late life developmental task as a complex and dynamic dialectic between ego-integrity and despair with substantial impact on older adults’ functioning. Limited knowledge is, however, available on how older adults cope with this task within the existentially challenging context of nursing homes. A person-oriented perspective within a longitudinal approach is implemented to test Erikson’s premise, offering insight into how old and frail adults come to terms with this task and how this process is related to better or worse psychological functioning. Three hundred twenty-seven adults living in nursing homes were interviewed three times by means of structured questionnaires, every 6 months. Typological methodology (latent class growth modeling) was used to reveal specific profiles of ego-integrity and despair and to test relations between profiles and psychological functioning over time. Three specific groups emerged (Despairing group, Struggling group, and Integrated group) and each group was associated with a unique pattern of psychological functioning (depressive symptoms, life satisfaction, subjective health). The Integrated group showed the most optimal functioning whereas the Despairing group, and to a lesser extent the Struggling group, showed suboptimal functioning. Furthermore, in the Despairing and Struggling group, different trajectories for subjective health were present, as compared to the Integrated group. Older adults in nursing homes handle the developmental tasks of late life in distinct and dynamic ways over time and these different trajectories are related to their psychological functioning. Our findings emphasize the need to focus on developmental psychological aspects in long-term care for older adults.