People In Residential Care Homes Research Articles

A visual art intervention program for older people with stroke in residential care settings: A feasibility study.

Stroke poses challenges to the physiological, psychosocial and spiritual well-being of affected individuals. As the impacts of stroke might not be reversible, a shift in focus to providing care is desirable. Visual art interventions using visual and symbolic art can help participants to express their feelings, give them a sense of choice and the feeling that they are retaining a sense of control, promote insights, restructure their sense of cognition and instil hope. There have been few studies on visual art interventions involving older people with stroke and none in residential care homes (RCHs). Theoretical support and rigorous research designs on the subject are lacking. Thus, this study seeks to address this research gap by examining the feasibility of a visual art intervention for older people in RCHs and exploring the impacts on their holistic well-being. This was a single-blinded, two-arm, randomised controlled feasibility study grounded on Watson's Caring Theory. The Holistic Well-Being Scale and Caring Factor Survey were used in the study, with three assessment time-points: before the intervention (T1), at the mid-point of the intervention (T2) and immediately after the intervention (T3). Sixty-one older people with stroke were recruited from 14 RCHs and randomised into the intervention and control groups. The recruitment rate was 44.53%, and the retention rate for the intervention group was 93.55%. Implementing the programme was affordable (at approximately US$126/head), the duration was acceptable (721 min) and the feedback from participants and staff of the RCHs was positive. The visual art intervention programme proved to be clinically feasible. This study adds new insights to the development of visual art interventions and to the caring sciences. The efficacy of the programme on holistic well-being has yet to be confirmed.

Effects of subjective perceptions of indoor visual environment on visual-related physical health of older people in residential care homes

Aging profoundly affects people's visual functions, and older persons generally show a declination of visual abilities. The indoor visual environment (IVE) in residential care homes (RCHs) is vital to ensure the visual-related physical health of older people (i.e., general vision, functional vision, visual acuity, physical discomfort, and injuries). The IVE, including opening design, interior design, and lighting conditions components, should be designed to satisfy older people's special visual needs. Hence, this study aims to investigate the effects of older people's subjective perceptions of the IVE on their visual-related physical health. In total, 197 questionnaires were collected from older persons living in RCHs. The integrated IVE–Visual-related Physical Health model was established based on multiple statistical methods for older residents in RCHs. The model revealed that the view out, window, corridors, furniture locations, curtains or louvers, handrails, and light level significantly affected the visual-related physical health of older people. Practical recommendations were proposed, including beds and seats near the windows with beautiful scenery, corridors with night lights and unblocked vision, automatic curtains with light sensors, handrails with a high color contrast with the background walls, minimum 200lx ambient lighting, etc. This study's findings provide valuable insight into enhancing the IVE in RCHs for older people's visual-related physical health.

OP32 A Multistep Multistakeholder Priority Setting Exercise For Fecal Incontinence

IntroductionFecal incontinence (FI) is the involuntary loss of feces and can affect up to 17 percent of community dwelling individuals, rising to 40 percent of older people in residential care homes. There is limited up-to-date evidence which formally set research priorities addressing FI. This project aimed to identify research topics of highest importance to key FI stakeholders.MethodsAn evidence gap map was produced incorporating three streams of evidence coded against predefined topic domains. The evidence streams included: emerging evidence identified through horizon scanning; existing evidence identified through systematic searches of bibliographic databases; and key FI stakeholder insights collected through an international survey. Findings were presented as a visual map to facilitate knowledge exchange during an online workshop with a purposeful sample of multidisciplinary stakeholders. The identified gaps in research were explored to see whether they were deemed representative of unmet needs, and as such, areas of priority to key FI stakeholders. Ideation techniques and group discussions were used to refine and rank priority areas.ResultsOverall, there was a mismatch between the existing and emerging evidence, and the priorities of key FI stakeholders. New pharmaceutical and medical technology innovations were limited. Eight percent of early-stage trials identified were concerned with the use of repurposed drugs. Within the existing evidence base, individual bowel management strategies and treatments were examined, however, key FI stakeholders desired interventions to improve patient education and the psychological aspects of living with FI. The five priority topics identified in order of importance are as follows: psychological support; lifestyle interventions; long-term effects; education; and constipation.ConclusionsThe robust methodology used to identify priority topics were successful in identifying broad and wide-ranging areas of importance to key stakeholders. The evidence gap map was a useful visual tool to facilitate knowledge exchange and highlight where research efforts have been focused historically, identifying a mismatch between the existing evidence base and what stakeholders consider important.

Managing malnutrition in older people living in residential care

Nursing and Residential CareVol. 24, No. 4 Clinical ReviewManaging malnutrition in older people living in residential careOmorogieva OjoOmorogieva OjoCorrespondence to: Omorogieva Ojo; E-mail Address: [email protected]Senior Lecturer in Primary Care, Faculty of Education and Health, University of Greenwich, Greenwich, London, UKSearch for more papers by this authorOmorogieva OjoPublished Online:2 May 2022https://doi.org/10.12968/nrec.2022.0014AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Dietetic Association. Malnutrition: food fact sheet. 2022. https://www.bda.uk.com/resource/malnutrition.html (accessed 11 March 2022) Google ScholarBrook S. Oral nutritional supplements: an integral part of malnutrition treatment. 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Effect on secondary care of providing enhanced support to residential and nursing home residents: a subgroup analysis of a retrospective matched cohort study

BackgroundThirteen residential care homes and 10 nursing homes specialising in older people in Rushcliffe, England, participated in an improvement programme. The enhanced support provided included regular visits from named general...

How young artist/facilitators use their unsettled identity to develop creative ageing practice

ABSTRACTThis article explores the practices of three young artist/facilitators, illustrating how they use their own age identity to develop expertise in working with older people in residential care homes. A research process of reflective dialogues reveals that they respond to the arts and drama-based workshop practices at creative ageing organisation Equal Arts with a growing value of their youthfulness. A self-defined ‘unsettled’ nature facilitates their work with older people, some with dementia who also share an ‘unsettled’ identity. The young practitioners are able to operate positively through relationships with older people, as well as re-view and re-new their own identity as artist/facilitators.

End-of-life services for older people in residential care homes in Hong Kong.

Good end-of-life care is needed for older people living in residential care homes with advanced irreversible chronic medical illnesses and cancers. At present, the usual practice of residential care homes is to send older residents to acute care hospitals when they are unwell, and some residents will die in hospital. Dying in hospital without choice for older people may not be in alignment with the principle of 'good death'. There are many barriers for older people to die in the place of their choice, particularly in a residential care home. In the community, to enhance end-of-life care for elderly people living in residential care homes, pilot end-of-life programmes have been organised by community geriatric assessment teams. In 2015, the Hong Kong Hospital Authority started the 'Enhance community geriatric assessment team support to end-of-life patients in residential care homes for the elderly' programme in four clusters. In the hospital setting, an end-of-life clinical plan and end-of-life ward in geriatric step-down hospitals may improve the quality of death of elderly people. In September 2015, the Hospital Authority guideline on life-sustaining treatment for terminally ill people was updated. Among other key end-of-life issues, careful (comfort) hand feeding was first mentioned in the guideline. The possible establishment of enduring powers of attorney for health care decision-making and enhancement of careful (comfort) hand feeding are new developments in the coming years.

Registered nurses' experience of delegating the administration of medicine to unlicensed personnel in residential care homes.

The aim was to describe registered nurses' experience in the context of delegating the administration of medication to unlicensed personnel in residential care homes. The residents in residential care homes have a need for extensive care and nursing, and large amounts of medicines are common practice. Registered nurses' workload and difficulties in fulfilling their duties, such as administration of medicines, have led to frequent delegation of this task between the registered nurses and unlicensed assisting personnel. It is, of course, a great responsibility to ensure that the care of the older people remains safe while maintaining quality in the prevailing situation. A qualitative inductive descriptive study. Data were collected using audio-recorded semistructured interviews with a purposive sample of 18 registered nurses and interpreted using manifest content analysis. The study was approved by the ethical research committee. Registered nurses found the organisation unsupportive with regard to nursing interventions. The delegation context was experienced as a grey zone; the rules and regulations were not in line with the unspoken expectation to delegate the administration of medicine to unlicensed personnel, in order to be able to manage their daily work. The slimmed organisation of residential care homes relies upon registered nurses' use of delegation of medicine administration to unlicensed assistant personnel. It becomes an inevitable assignment entailing a challenging responsibility for patient safety and the quality of care. The results of this study may contribute to a better understanding of the complexity of caring for older people in residential care homes and to improving the work environment of all healthcare personnel.

From Adolescents to Old Age--To Design Preventive Activities Effectively

Same of the projects funded under the German Ministry of Education and Research's national prevention research initiative focusing explicit on adults. Those encompass because of increasing diversity different target groups. In this article the target groups are divided in adolescents, parents, persons in the working environment and elderly people in residential care homes. Accordingly, the foci of these projects are with regard to contents multifaceted, as well.

Improving the dietary intake of under nourished older people in residential care homes using an energy‐enriching food approach: a cluster randomised controlled study

To examine whether the nutritional status of aged undernourished residents in care could be improved through dietary modification to increase energy intake but not portion size. A 12-week cluster randomised controlled trial was carried out in 21 residential care homes. Participants comprised undernourished residents with a body mass index (BMI) <18.5kgm(-2) . All menus were analysed to evaluate nutrient provision. Energy and macronutrient intakes of undernourished residents were estimated using 3-day weighed food intake diaries. Those resident in homes randomised to intervention had their usual meals enriched with energy-dense foods to a maximum of +1673 kJ day(-1) . Of 445 residents screened, 41 (9%) had a BMI <18.5kgm(-2) and entered the study. Despite adequate food provision, energy and macronutrient intakes were below UK dietary reference values. Mean (SEM) energy intake increased [+556 (372) kJ, P=0.154] in residents allocated to intervention but fell in those residents in 'control homes' receiving usual care [-151 (351) kJ, P=0.676]. Weight change [+1.3 (0.53)kg, P=0.03] was seen in intervention residents but not in controls [-0.2 (1.5)kg, P=0.536]. Between-group differences for changes in weight and energy intake were not significant (P=0.08 and 0.20, respectively). Six residents allocated to the intervention increased their BMI >18.5kgm(-2) (P=0.018). Achieving weight gain in frail older people is difficult. These results suggest that enriching food could help address undernutrition and slow chronic weight loss. Interventions of a longer duration are needed to confirm or exclude the value of food enrichment.

Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory

BackgroundOptimizing the dietary intake of older people can prevent nutritional deficiencies and diet-related diseases, thereby improving quality of life. However, there is evidence that the nutritional intake of older people living in care homes is suboptimal, with high levels of saturated fat, salt, and added sugars. The UK Food Standards Agency therefore developed nutrient- and food-based guidance for residential care homes. The acceptability of these guidelines and their feasibility in practice is unknown. This study used the Normalization Process Theory (NPT) to understand the barriers and facilitators to implementing the guidelines and inform future implementation.MethodsWe conducted a process evaluation in five care homes in the north of England using qualitative methods (observation and interviews) to explore the views of managers, care staff, catering staff, and domestic staff. Data were analyzed thematically and discussed in data workshops; emerging themes were then mapped to the constructs of NPT.ResultsMany staff perceived the guidelines as unnecessarily restrictive and irrelevant to older people. In terms of NPT, the guidelines simply did not make sense (coherence), and as a result, relatively few staff invested in the guidelines (cognitive participation). Even where staff supported the guidelines, implementation was hampered by a lack of nutritional knowledge and institutional support (collective action). Finally, the absence of observable benefits to clients confirmed the negative preconceptions of many staff, with limited evidence of reappraisal following implementation (reflexive monitoring).ConclusionsThe successful implementation of the nutrition guidelines requires that the fundamental issues relating to their perceived value and fit with other priorities and goals be addressed. Specialist support is needed to equip staff with the technical knowledge and skills required for menu analysis and development and to devise ways of evaluating the outcomes of modified menus. NPT proved useful in conceptualizing barriers to implementation; robust links with behavior-change theories would further increase the practical utility of NPT.

Addressing the nutritional needs of older people in residential care homes

In the UK and Europe, malnutrition in older people is a significant and continuing problem. Malnutrition predisposes to disease, impedes recovery from illness, increases mortality and is costly to society. Despite the high number of older people potentially at risk, malnutrition in care homes has been under explored. There is concern that national guidelines regarding the nutritional care of older people in residential care homes are not always implemented. This qualitative study explored the factors that influence the nutritional care provided to residents in two different types of local authority residential care homes (providing personal care) in Wales. One home had communal dining rooms; the other had eight bedded units with their own kitchen and dining facilities. The sample of 45 participants, comprised 19 staff (managers, care and catering staff), 16 residents and 10 residents' relatives. Data were collected using semi-structured interviews, focus groups, observation and documentary review between August 2009 and January 2010. This paper focuses on how staff assessed and addressed residents' nutritional needs. In both care homes, staff strove to be responsive to residents' dietary preferences, provided person-centred care and worked in partnership with residents and their families to provide nutritious food in a homely environment. Neither home conducted nutritional screening to identify those at risk of malnutrition, contrary to national guidelines, but relied on ad hoc observation and monitoring. The staff's knowledge of special dietary needs was limited. A need for further training for care home staff regarding the importance of nutrition in maintaining health in older people, use of nutritional screening and special dietary needs was identified. Shared nutrition training between health and social care staff needs expansion and policy implications in terms of an enhanced regulatory focus on maintaining nutritional needs in care homes are proposed.

Caries prevention for older people in residential care homes

When attempting to prevent dental caries in older people who live in residential care homes, what is the effectiveness and relative cost benefit of high concentration fluoride toothpaste compared with fluoride varnish application?

Unidentified under‐nutrition: dietary intake and anthropometric indices in a residential care home population

Research investigating the nutritional status of older people in residential care homes is scant. To determine the anthropometric measures and dietary intakes of older people in this setting as a basis for future intervention studies. Dietary intake was assessed using 3-day-weighed food records, nutritional status was evaluated using anthropometric measurements (knee height to predict standing height, and body weight). Catering provision was assessed using a computer-based menu assessment tool (CORA). Mean body mass index (BMI) for the 34 participants was 22.2 kg m(2) (range 14.5-34.4). Six participants (17.6%) had a BMI < or =18.5 kg m(2) with a further seven identified as having a BMI >18.5 but <20 kg m(2). Only two subjects with BMI <18.5 kg m(2) were prescribed oral supplements. In both men and women, recorded mean energy intakes were below current estimated average requirements by 24% and 22% respectively. Despite adequate food provision, under-nutrition was prevalent and, in the majority of cases, unidentified and untreated. A larger study is warranted to investigate whether improved nutritional intake is achievable through dietary modification. These data indicate that a sample size of around 60, with 90% power and at the 5% significance level, is required to detect a difference of 1674 kJ between groups of residents in an intervention study following a cluster randomized design.

What has architecture got to do with dementia care?: Explorations of the relationship between quality of life and building design in two EQUAL projects

Two projects in the EQUAL programme explore aspects of the influence of building design on the quality of life of people with dementia. Design in Caring Environments (DICE) examined the quality of life of people in residential care homes in relation to building design features. INDEPENDENT (Investigating Enabling Environments for People with Dementia) is a current project with the aim of developing technologies to enhance quality of life by supporting enjoyable activities. One aspect of INDEPENDENT is an exploration of the interaction between spatial settings and meaningful activity, to highlight factors that support and enable activity and to identify barriers. Findings from both projects suggest that a more creative approach to the management of buildings would enhance the well‐being of residents; under‐use of facilities is common. Meaningful space that supports activity is therapeutic but spaces that give confused messages are common in buildings used by older people. Tools to evaluate buildings have a potential role in the long‐term management of facilities to help identify underused spaces, spatial confusion and barriers to activity. Quality of life was shown to be poorer in buildings that prioritise safety and health; buildings that support activity positively by providing good assistive devices, giving people control of their environment and affording good links with the community have a positive association with well‐being.

Put care back into homes

Concerns over the provision of appropriate care for older people in residential care homes have been expressed with increasing stridency for some time. Two years ago the RCN congress resolved to lobby governments for increased care home funding to prevent the escalating rate of care home closures.

Readers' Letters

Sir I have worked as a district nurse for 4 years now, visiting older people in residential care homes. The thing I love most about my job is helping people to become as independent as possible and reducing the need for hospital admissions, but it is not an easy job: it is both physically and emotionally demanding.

Older people in care homes and the primary care nursing contribution: a review of relevant research

Claire Goodman and Rosemary J Woolley Primary Care Nursing Research Unit, University and King’s Colleges,London, UKIn the UK, older people who are resident in care homes because of their needs forsocial support and personal care receive their health care from primary health care.Although there is increasing input from district nurses in care homes (Audit Com-mission, 1999), there is little knowledge or recognition of the primary care nursingcontribution. This paper reviews two types of research literature: studies that considerthe health care needs of older people in residential care homes that could informnursing support and interventions in care homes, and research that describes thenursing involvement with these settings. The paper argues that on the basis of theresearch reviewed many of the health problems older people in care homes experi-ence could be avoided or improved by primary care nursing support and intervention.A reassessment is needed of how the interface between community and residentialcare is managed so that older people in care homes have access to appropriate healthcare support.Key words : care homes; district nurses; older people; primary care nursing; primaryhealth care; residential homes

District nurse involvement in providing palliative care to older people in residential care homes.

Although less than 15% of older people in care homes die of a terminal disease such as cancer, many more die following a period of slow deterioration. In the UK, residents of care homes receive their nursing care from primary healthcare providers. This article reports on a study that describes how district nurses and care home managers define their responsibilities when caring for residents who are dying. The findings presented are from a detailed survey of 89 district nurse team leaders and 96 care home managers. District nurses were the most frequent health professionals visiting care homes, but less than half reported involvement in palliative care. The differing priorities and perceptions of participants regarding what constituted nursing and personal care influenced older people's access to palliative care services. Furthermore, the organization of care and the stability of the care home workforce affected participants' ability to establish ongoing supportive working relationships. It is argued that unless there is an organizational review of current practice, older people will continue to have unequal access to generalist and specialist palliative care.

District nurses' experiences of providing care in residential care home settings.

Little research describes the involvement and contribution of primary health care services in residential homes, despite policy and research concerns that older people in residential homes are a vulnerable population for whom care must be improved. The aim of this research was to explore the actual and potential contribution of primary care nurses in residential homes for older people, particularly district nurses. Five focus groups were held with district nurses in one county in England, to explore how participants represented their views, values and experiences of working in residential homes. Our major finding was the importance of context in shaping the experience of district nursing involvement. General practitioner attachment determined the frequency of visiting homes and affected workload. District nurses had regular contact with residential homes for discrete nursing tasks, but appropriateness of referrals and input was not agreed. The focus group discussions with district nurses revealed how problematic their work in residential homes was and a lack of consensus about their role. The data suggested that uncertainty about providing care in a setting that straddles the health and social care, public and private divide, and anxieties about managing their workload overshadowed their acknowledged concerns about the older people in residential care homes. Further research is needed to substantiate the findings, obtain residents' views and address issues of how to achieve integrated and equitable health and social care for this group.