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Enabling meaningful activities and quality of life in long-term care facilities: the stepwise development of a participatory client-centred approach in Flanders
- Authors:
- DE VRIENDT Patricia, et al
- Journal article citation:
- British Journal of Occupational Therapy, 82(1), 2019, pp.15-26.
- Publisher:
- Sage
Introduction: Meaningful activities of daily living promote the quality of life of residents of long-term care facilities. This project aimed to develop an approach to enable meaningful activities of daily living and to guide long-term care facilities in a creative and innovative attitude towards residents' meaningful activities of daily living. Method: The approach was developed in six steps: (1) in-depth-interviews with 14 residents; (2) a survey with 171 residents; (3) a systematic map and synthesis review on interventions enriching meaningful activities of daily living; (4) qualitative analysis of 24 ‘good examples’ and, to support future implementation, (5) focus groups with staff (n = 69). Results determined the components of the new approach which was (6) pilot-tested in one long-term care facility. Quantitative and qualitative data were gathered concerning benefits for the residents and feasibility for the staff. Results: A client- and activity-oriented approach was developed, characterised by an active participatory attitude of residents and staff and a systematic iterative process. Significant positive effects were found for the number of activities, the satisfaction with the leisure offered, the social network, medication use, but not for quality of life. The approach appeared to be feasible. Conclusion: This approach stimulates residents' meaningful activities of daily living and social life. Further investigation is needed to evaluate its outcome and implementation potentials.
Cognitive functioning and quality of life: Diverging views of older adults with Alzheimer and professional care staff
- Authors:
- DEWITTE Laura, VANDENBULCKE Mathieu, DEZUTTER Jessie
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(8), 2018, pp.1074-1081.
- Publisher:
- Wiley
Objective: Staff ratings of quality of life (QOL) in dementia are often lower and more strongly related to the cognitive functioning of the person with dementia than self‐ratings. However, cognition‐related items in QOL measures and limited cognitive screening measures hamper a clear understanding of the relationship, two issues addressed in the current study. Methods: The authors collected data of 88 pairs of older adults with Alzheimer disease and their professional caregivers in 9 residential care settings. Both self‐report and staff report of the QOL of residents were assessed with the Quality of Life in Alzheimer's Disease. Cognitive functioning was assessed with the Mini‐Mental State Examination and a battery of specific cognitive measures. Results: Intraclass correlations and a paired sample t test confirmed a discrepancy between self‐rating and staff rating, with staff significantly underestimating QOL as experienced by the resident. After removing the possibly confounding memory item of the Quality of Life in Alzheimer's Disease, Mini‐Mental State Examination score remained a significant predictor of staff ratings but not self‐ratings in regression analyses. Exploratory analyses of specific cognitive measures showed a significant contribution of a memory test of intentional visual association learning in the prediction of staff‐rated QOL. Conclusions: Staff reports cannot simply substitute reports of the subjective experience of residents with Alzheimer, so both judgments should be taken into account to form an adequate picture of QOL. Staff might be guided more strongly by a cognitive point of view when evaluating QOL of residents with Alzheimer disease, while the latter might have shifted their evaluation standards to cope adequately with the challenges posed by their disease. (Edited publisher abstract)
Detecting frail, older adults and identifying their strengths: results of a mixed-methods study
- Authors:
- DURY Sarah, et al
- Journal article citation:
- BMC Public Health, 18(191), July 2018, Online only
- Publisher:
- BioMed Central Ltd
Background: The debate on frailty in later life focuses primarily on deficits and their associations with adverse (health) outcomes. In addition to deficits, it may also be important to consider the abilities and resources of older adults. This study was designed to gain insights into the lived experiences of frailty among older adults to determine which strengths can balance the deficits that affect frailty. Methods: Data from 121 potentially frail community-dwelling older adults in Flemish-speaking Region of Belgium and Brussels were collected using a mixed-methods approach. Quantitative data were collected using the Comprehensive Frailty Assessment Instrument (CFAI), Montreal Cognitive Assessment (MoCA), and numeric rating scales (NRS) for quality of life (QoL), care and support, meaning in life, and mastery. Bivariate analyses, paired samples t-tests and means were performed. Qualitative data on experiences of frailty, frailty balance, QoL, care and support, meaning in life, and mastery were collected using semi-structured interviews. Interviews were subjected to thematic content analysis. Results: The “no to mild frailty” group had higher QoL, care and support, meaning in life, and mastery scores than the “severe frailty” group. Nevertheless, qualitative results indicate that, despite being classified as frail, many older adults experienced high levels of QoL, care and support, meaning in life, and mastery. Respondents mentioned multiple balancing factors for frailty, comprising individual-level circumstances (e.g., personality traits, coping strategies, resilience), environmental influences (e.g., caregivers, neighborhood, social participation), and macro-level features (e.g., health literacy, adequate financial compensation). Respondents also highlighted that life changes affected their frailty balance, including changes in health, finances, personal relationships, and living situation. Conclusion: The findings indicate that frailty among older individuals can be considered as a dynamic state and, regardless of frailty, balancing factors are important in maintaining a good QoL. The study investigated not only the deficits, but also the abilities, and resources of frail, older adults. Public policymakers and healthcare organizations are encouraged to include these abilities, supplementary or even complementary to the usual focus on deficits. (Edited publisher abstract)
How do older adults experience and perceive socially assistive robots in aged care: a systematic review of qualitative evidence
- Authors:
- VANDEMEULEBROUCKE Tijs, DIERCKX De CASTERLE Bernadette, GASTMANS Chris
- Journal article citation:
- Aging and Mental Health, 22(2), 2018, pp.149-167.
- Publisher:
- Taylor and Francis
Objectives: The aim of this review was to gain a better understanding of how older adults experience, perceive, think, and feel about the use of socially assistive robots (SARs) in aged care settings. Method: The authors conducted a literature search for studies that used a qualitative or a mixed-method approach having a significant qualitative element. Pubmed, Cinahl, Embase, Scopus, and Web of Science electronic databases were queried. Candidate articles published in journals and conference proceedings were considered for review. Two independent reviewers assessed the included studies for methodological quality using the Critical Appraisal Skills Program, after which data on subjects’ self-reported opinions and perceptions were extracted and synthesised using thematic analyses. Results: Seventeen studies producing 23 publications were included. Based on the opinions of older adults, four themes emerged in relation to the use of SARS: (1) roles of a SAR; (2) interaction between the older adult and the SAR, which could be further subdivided into (a) the technical aspect of the interaction and (b) the human aspect of the interaction; (3) appearance of the SAR; and (4) normative/ethical issues regarding the use of SARs in aged care. Conclusions: Older adults have clear positive and negative opinions about different aspects of SARs in aged care. Nonetheless, some opinions can be ambiguous and need more attention if SARs are to be considered for use in aged care. Understanding older adults’ lived experiences with SARs creates the possibility of using an approach that embeds technological innovation into the care practice itself. (Edited publisher abstract)
Experiences of neighbourhood exclusion and inclusion among older people living in deprived inner-city areas in Belgium and England
- Authors:
- BUFFEL Tine, PHILLIPSON Chris, SCHARF Thomas
- Journal article citation:
- Ageing and Society, 33(1), 2013, pp.89-109.
- Publisher:
- Cambridge University Press
This article explores conceptual and empirical aspects of the social exclusion/inclusion debate in later life, with a particular focus on issues of place and space in urban settings. Exploratory findings are reported from two empirical studies in Belgium and England, which sought to examine experiences of social exclusion and inclusion among people aged 60 and over living in deprived inner-city neighbourhoods. Semi-structured interviews were conducted with an ethnically diverse sample of 102 older people in Belgium and 124 in England. Thematic analysis of interview data identifies four issues in relation to the neighbourhood dimension of social exclusion/inclusion in later life: experiences of community change; feelings of security and safety; the management of urban space; and strategies of control. The results suggest that neighbourhoods have a significant influence on shaping the experience of exclusion and inclusion in later life, with a number of similarities identified across the different study areas. The article concludes by discussing conceptual and policy issues raised by the research. (Publisher abstract)
Behavioral symptoms in mild cognitive impairment as compared with Alzheimer's disease and healthy older adults
- Authors:
- VAN DER MUSSELE Stefan, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(3), 2013, pp.265-275.
- Publisher:
- Wiley
Mild cognitive impairment (MCI) is a clinical concept that describes patients who are in an intermediate state between normal aging and dementia. It does not generally affect their activities of daily living but complex instrumental functions may be minimally impaired. Although behavioural symptoms are common in MCI they are not included in the concept. The aim of this study was to characterise behaviour in MCI compared with Alzheimer's disease (AD) and healthy older patients. The data were drawn from the baseline of a longitudinal study of behavioural symptoms of dementia and MCI. The study population, consisting of 270 MCI, 402 AD patients, and 108 healthy controls from Antwerp, underwent a battery of tests and assessments. Moderate-to-severe behavioural symptoms were present in 13% of MCI patients, compared with 39% in AD patients and 3% in controls. The general severity of behavioural symptoms was intermediate between controls and AD patients. The three most common symptoms in MCI patients were aggressiveness (49%), affective disturbance (45%), and anxiety (38%); in AD patients, they were aggressiveness (60%), activity disturbances (54%), and psychosis (40%). Overall the prevalence and severity of frontal lobe symptoms, aggressiveness, activity disturbances, and delusions was intermediate between normal aging and AD and the severity of physically non-aggressive, verbally agitated behaviour and the severity of depressive symptoms were also intermediate.
Perpetrators of abuse against older women: a multi-national study in Europe
- Authors:
- DONDER Liesbeth De, et al
- Journal article citation:
- Journal of Adult Protection, 13(6), 2011, pp.302-314.
- Publisher:
- Emerald
Results from part of the prevalence study Abuse and Violence against Older Women in Europe, conducted in Finland, Austria, Belgium, Lithuania and Portugal in 2010, are presented in this paper. The study focused on home-dwelling women aged 60 years or older and included interviews with 2,880 older women. This paper explores the findings concerning perpetrators of abuse among older women living in the community and whether differences between perpetrators of different forms of abuse could be detected. The results showed that 28.1% of older women reported experiencing at least one kind of violence and abuse in their own home in the last 12 months by someone who was close to them. The findings indicated that emotional abuse occurs most often, followed by financial abuse, and that the current partner or spouse most often commits the abuse, but that depending on the type of abuse different perpetrators are more likely. The paper includes tables showing rates of different kinds of abuse and perpetrators of abuse, including types of abuse, levels of severity, and victim characteristics.
Older people’s perceptions of assistive technology – an exploratory pan-European study
- Authors:
- WILLIAMS Veronika, MCCRINDLE Rachel, VICTOR Christina
- Journal article citation:
- Journal of Integrated Care, 18(1), February 2010, pp.38-44.
- Publisher:
- Emerald
This paper describes a survey undertaken to explore how assistive technology in the form of a wrist-worn device is perceived by older people. The survey was part of a larger study funded by EU Framework 6, ENABLE, which involved development of a wrist-worn assistive technology device capable of providing a variety of functions such as an alarm system, falls detection, navigation through GPS and an event reminder, thus enabling older people and their carers to live more independently and with reassurance. The purpose of the survey was to gain insights into the general issues that concern older people if they are required to wear and use assistive technology, and to identify more specifically the views of older people on the potential functionalities of the intended, future wrist-worn device. The questionnaire was sent out to participants in the UK, Czech Republic, Greece, and Belgium, and 158 completed questionnaires were returned. The results demonstrated a number of older people engaging with technology; a large number used a mobile phone, and almost half owned and used a computer and the internet. The device functions relating to emergency alarm systems and fall detections were rated as important. However, despite the potential benefits, it is clear from the results of the survey that privacy and confidentiality are significant concerns which can impede successful implementation.
Rights, risks and restraint-free care of older people: person-centred approaches in health and social care
- Editors:
- HUGHES Rhidian, (ed.)
- Publisher:
- Jessica Kingsley
- Publication year:
- 2010
- Pagination:
- 224p., bibliog.
- Place of publication:
- London
This book provides health and social care professionals with an authoritative reading resource on the ethics and use of restraint. It provides an overview of the different forms of restraint, the conditions under which they are used and their implications for the health and wellbeing of older people. Practical approaches to minimising restraint are then explored, underlining the importance of person-centred care. Innovative programmes and approaches to reducing the use of restraint are described and assessed, and case studies are drawn upon to highlight practice challenges and their effective resolutions. The perspectives of older people and their carers and families, as well as of professionals, commissioners and regulators of health and social care, are also taken into account. The contributors are drawn from an international range of health and social care settings, as well as from the academic world.
The process of definitive institutionalization of community dwelling demented vs non demented elderly: data obtained from a network of sentinel general practitioners
- Authors:
- SCHOENMAKERS Birgitte, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(5), May 2009, pp.523-531.
- Publisher:
- Wiley
The aim of the present study was to investigate the differences between characteristics of community dwelling demented and non demented elderly and their caregivers at the moment of definitive institutionalization. The study is a cross-sectional analysis performed on data obtained from a Network of Sentinel General Practitioners. Older demented patients with several concomitant diseases were mainly placed because of unmanageable behavioural disturbances. Strikingly, these dementia patients were more often confronted with a time delay in definitive institutionalization due to their high care dependence. Although burden in the dementia family caregivers was an important motivation for definitive institutionalization, it did not seem to be a motive in the final institutionalization circumstances. Behavioural disturbances are independently of caregiver burden, professional support, or a spousal relationship the main direct reason for institutionalization of community dwelling demented elderly. The way caregivers feel supported might play the key role in the final placement decision