People In Institutional Settings Research Articles

EXPLORING THE IMPACT OF AN EBOOK CLUB PROGRAM ON APATHY AMONG OLDER CANADIANS IN LONG-TERM CARE: A FEASIBILITY STUDY

Abstract Apathy is a common and persistent problem among older people in institutional settings. Research has shown that apathy can lead to rapid decline in cognitive status, serious functional impairments and decrease in the life span of those affected, yet it is under-researched, and under-managed. The aim of this study was to explore ways by which apathy can be mitigated in this population using eReader technology during book club program implementation. We recruited participants from various long-term care facilities (N=18) and each participants took part in semi-structured interviews, and self-reported apathy assessment both at the start and end of the program. We tracked engagement in the eBook club and time commitment to reading using a logbook. The findings suggest that older people, including persons with mild to moderate dementia, are open to adopting new technologies and the use of eReaders during book club programs is feasible for long term care facilities. Overall, we found that the use of eReader technology is a safer and more effective way of delivering book club program to older people in long term care facilities particularly during pandemic such as COVID 19 as they are easy to disinfect in comparison to physical books. We recommend that long term care staff should adapt eReaders into their existing book club or literacy programs and consider utilizing it as a strategy to prevent or manage apathy in this population.

Components of interventions to reduce restrictive practices with children and young people in institutional settings: the Contrast systematic mapping review

Background Incidents in which children or young people experience severe distress or harm or cause distress or harm to others occur frequently in children and young people’s institutional settings. These incidents are often managed using restrictive practices, such as restraint, seclusion, sedation or constant observation; however, these also present significant risks of physical and psychological harm to children and young people as well as staff. Numerous interventions aim to reduce the use of restrictive techniques, but research is hampered by limited attention to specific intervention components. The behavior change technique taxonomy may improve reporting by providing a common language for specifying the content and mechanisms of behaviour change. This study aimed to identify, standardise and report the effectiveness of components of interventions to reduce restrictive practices in children and young people’s institutional settings. Objectives To map interventions aimed at reducing restrictive practices in children and young people’s institutional settings internationally, to conduct behaviour change technique analysis of intervention components, to identify process elements, and to explore effectiveness evidence to identify promising behaviour change techniques and compare the results with those found in adult psychiatric inpatient settings in a companion review. Design Systematic mapping review with programme content coding using the behavior change technique taxonomy. Review methods Eleven relevant English-language health and social care research databases 1989–2019 [including Applied Social Sciences Index (ASSIA), Criminal Justice Abstracts, Educational Resources Information Center (ERIC), MEDLINE and PsycInfo®], grey literature and social media were searched during 2019 (updated January 2020). Data extraction, guided by Workgroup for Intervention Development and Evaluation Research (WIDER), Cochrane Library and theory coding scheme recommendations, included intervention characteristics and study design and reporting. Screening and quality appraisal used the Mixed Methods Appraisal Tool. The behavior change technique taxonomy was applied systematically, and interventions were coded for behaviour change technique components. Outcomes data were then related back to these components. Results There were 121 records, including 76 evaluations. Eighty-two interventions, mostly multicomponent, were identified. Evaluation approaches commonly used a non-randomised design. There were no randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Four clusters (i.e. goals and planning, antecedents, shaping knowledge, and feedback and monitoring) contained the majority of identified behaviour change techniques and were detected in over half of all interventions. Two clusters (i.e. self-belief and covert learning) contained no identified behaviour change techniques. The most common setting in which behaviour change techniques were found was ‘mental health’. The most common procedure focused on staff training. The two most common behaviour change techniques were instruction on how to perform the behaviour and restructuring the social environment. Promising behaviour change techniques included instruction on how to perform the behaviour, restructuring the social environment, feedback on outcomes of behaviour and problem-solving. Compared with the companion review, service user perspectives were more sparse and there was more interest in trauma-informed approaches. Effectiveness evidence, range of interventions and reporting were broadly similar. Limitations Poor reporting may have prevented detection of some behaviour change techniques. The finding that the evidence was weak restricted the feasibility of examining behaviour change technique effectiveness. Literature searches were restricted to English-language sources. Conclusions This study generated, to our knowledge, the first review of evidence on the content and effectiveness of interventions to reduce restrictive practices in children and young people’s institutional settings. Interventions tend to be complex, reporting is inconsistent and robust evaluation data are limited, but some behaviour change techniques seem promising. Future work Promising behaviour change techniques could be further explored. Better evidence could help address the urgent need for effective strategies. Study registration This study is registered as PROSPERO CRD42019124730. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.

Burden of Oral Symptoms and Health-Related Quality of Life in Long-Term Care Settings in Helsinki, Finland.

Poor oral health may complicate eating and deteriorate nutritional status. However, little is known about how the burden of oral symptoms (OS) is associated with the health-related quality of life (HRQoL) of vulnerable older people in institutional settings. This study explores how the burden of certain OS (chewing problems, swallowing difficulties, dry mouth) is associated with functioning, morbidity, nutritional status and eating habits. It also examines the association between the OS burden and HRQoL. A cross-sectional study in 2017. All long-term care wards in Helsinki, Finland. 2401 older residents (74% females, mean age 83.9). Nurses assessed the residents and completed questionnaires on the participants' demographics, functional status, diagnoses, OS and eating habits. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and HRQoL with a 15-dimensional instrument (15D). Of the residents, 25.4% had one OS and 16.6% two or three OS. OS burden was associated linearly with poorer cognitive and physical functioning and a higher number of comorbidities, edentulousness without dentures, and less frequent teeth brushing/denture cleaning. OS burden was also associated with malnutrition, lower BMI and eating less during main meals. In the multivariate analyses adjusted for various confounding factors, a higher number of OS was associated with lower HRQoL. OS burden correlated with nearly all dimensions of HRQoL. Oral symptoms are associated with generic HRQoL. Therefore, OS should be regularly assessed and managed in daily care.

Non-response in surveys of very old people.

Very old people are known to participate less often in social surveys than younger age-groups. However, survey participation among very old people in institutional settings is understudied. Additionally, the focus of the literature is on response rates, which neglects the complexity of the process of survey participation. The present study uses standard definitions of the American Association for Public Opinion Research to give a detailed description of survey participation among very old people, including those in institutional settings. Data come from a German survey on quality of life and subjective well-being of persons aged 80-84, 85-89, and 90+ (N = 1800). The present study (a) estimates contact, cooperation, response, and refusal rates and (b) identifies associations of age, sex, and type of residence with each of these rates. Weighted outcome rates for the survey were: contact = 66.0%, cooperation = 39.6%, response = 26.1%, and refusal = 26.9%. Age, sex, and type of residence were not associated with the contact, cooperation, and response rate. Lower refusal rates were found for people aged 90+, men, and institutionalized people. Additional analyses showed higher rates of non-interviews due to health-related reasons for institutionalized people and those aged 90+. Overall, results indicate that institutionalized and non-institutionalized people showed similar levels of survey participation. Willingness to participate is a key factor for women and people in private households, while the ability to participate is more important for institutionalized people.

Physical abuse against elderly persons in institutional settings

IntroductionPeople over 65 years old are expected to be an increasing group exposed to abuse. Despite the well-studied intra-familial abuse, institutional abuse still lacks a proper understanding about its determinants and characteristics. AimThe general objective of this study is to provide a better knowledge about physical abuse against elderly people in institutional settings, in order to contribute to a timely detection, correct forensic diagnosis and prevention of these cases. MethodsA retrospective study was conducted through the analysis of forensic medical exams performed in the North Forensic Medical Services of Portugal, between 2004 and 2013, to elderly persons allegedly victims of physical abuse in an institutional setting by a caregiver (n = 59). ResultsAll the alleged cases occurred in nursing homes and in most of them (93.2%) the charges were against the institution and not focussing on a particular individual. The alleged victims were mainly female (79.7%), 75 years or older (75.9%), presenting a severe disability (55.9%) and 47.2% being unable to communicate. No injuries or post-traumatic pain were found in 55.9% of the cases to support the charge of physical abuse. Only in 6.8% of the cases were the forensic medical findings suggestive of physical abuse and, although this was not the object of the examination, 69.1% were considered suggestive or highly suggestive of neglect. A statistically significant association was found between the alleged victim's degree of disability and the occurrence of neglect (p = 0.003). ConclusionThe sample's size seems to be underestimated, probably due to lack of detection and/or reporting. The condition of these persons, mainly related with their inability to perceive abusive behaviours and/or to disclose them (mostly by physical and/or mental disability), as well as their reluctance to press charges due to fear of reprisal, affects significantly the detection and diagnosis of physical abuse, particularly in whom injuries are not obvious. In anticipation to the rapid ageing of the population, it is urgent to analyse and understand this emerging issue so that social policies and regulation may be developed, in an effort to protect the elderly, as well as to make improvements in the professionals' skills.

Intimate relationships between older people in institutional settings: Ageism, protection or fear?

Summary Objectives To clarify the implications of human rights for older people within institutional settings wishing to continue or to develop intimate relationships. To identify key issues facing practitioners responding to intimate relationships in residential settings. To emphasise the importance of avoiding assumptions based on stereotypical views of older people. Equipment and methods A review of the literature and the law on intimate relationships between older people in residential settings.

Law enforcement and criminal justice personnel interactions with transgender people in the United States: A literature review

Abstract This literature review examines research exploring the interactions between transgender people and law enforcement and criminal justice (LECJ) personnel in the U.S. to better understand the experiences of transgender people who come into contact with the criminal justice system. A search of existing academic literature, public health reports, and advocacy group publications revealed 33 studies that contained information about transgender people's interactions with LECJ personnel. Results highlight how large percentages of transgender people experience arrest and incarceration, unjustified stops and arrest, disrespect and poor case handling, and abuse and violence from LECJ personnel while in their communities. Large percentages of transgender people in institutional settings also reported abuse committed by criminal justice personnel, including harassment, assault, and a lack of protection from other inmates. This review also highlights evidence of discriminatory and abusive treatment when transgender victims seek assistance from the legal system. Taken together, this study suggests a need for further work to de-stigmatize the legal and criminal justice systems.

Creating and maintaining oral health for dependent people in institutional settings

The absolute number and percentage of the population of dependent individuals in institutional settings are growing dramatically in the United States. The current dominant office-based oral health delivery system is not adequately addressing the oral health needs of these populations and is unlikely to do so in the future. There are multiple challenges in providing oral health services for dependent people in institutional settings. To achieve improvements in the oral health of these populations, we must change the education of oral health professionals, educate staff in institutional settings about oral health, integrate oral health activities into general health and social service systems, use existing oral health professionals in new ways in community settings, develop new categories of oral health professionals, and reform oral health delivery and reimbursement systems. Developing new models of oral health services for dependent individuals in institutional settings may provide an opportunity to create a new paradigm of care based on integration of oral health services with general health and social services with an emphasis on prevention and health promotion activities.

The Care and Abuse of Minoritized Ethnic Groups: The Role of Statutory Services

Abuse in care relationships is an increasing concern in social policy and service provision. Attention has been drawn to the abuse of cared-for people in their own homes, the abuse of carers by family members and the abuse of people in institutional settings. Drawing on qualitative research with carers/carees from South Asian and African-Caribbean backgrounds, this paper explores a different conceptualization of abuse which moves away from an interpersonal understanding, to one that recognizes structural inequalities as a form of ‘institutional’ abuse of carers and those who receive care. This reconceptualization of abuse gives particular attention to forms of racism and discrimination in the provision of services to minoritized carers/cared-for people. It therefore makes significant contributions to discussions of caring and race equality in the health and social care fields.

Activity

This article presents a selected review of literature concerning environmental influences on activity participation by the elderly person, the relationship between activity engagement and satisfaction in the environment, and the ways in which activity participation influences environmental experiences. The studies reviewed examine such factors as the amount and quality of activities offered, the types of roles available to elderly people in institutional settings, and how elderly people themselves experience and perceive their current living environments. The literature underscores the need for an awareness of how environmental variables can affect the individual's involvement in activity, as well as an understanding of how activity engagement may relate to the individual's evaluation of the environment and of oneself. The article concludes with some general implications for clinical intervention with institutionalized and non-institutionalized elderly people.