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Identifying changeable barriers to family involvement in the nursing home for cognitively impaired residents
- Author:
- PORT Cynthia Lindman
- Journal article citation:
- Gerontologist, 44(6), December 2004, pp.770-778.
- Publisher:
- Oxford University Press
Barriers to family involvement in the US nursing home with the potential for change through intervention were examined, including transportation, caregiver health, relationships with staff, and resident characteristics. Data were collected for 93 family caregiver–resident pairs by means of telephone interviews and chart review. Regression modelling was used to identify relationships between involvement (caregiver visit frequency) and the changeable barriers after the known variables of distance, kinship, payment source, length of stay and cognitive function were taken into account. Lower visit frequency was found for caregivers reporting problems with transportation, poor relationships with staff and a smaller network of supportive family and friends. Higher caregiver anxiety was related to higher visit frequency. Several barriers to family involvement are shown to be as or more influential than ones identified in previous research, thus providing empirical support for interventions currently used as well as suggesting new areas for intervention.
Facilitators and barriers to optimizing eating performance among cognitively impaired older adults: a qualitative study of nursing assistants’ perspectives
- Authors:
- LIU Wen, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 19(6), 2020, pp.2090-2113.
- Publisher:
- Sage
Background and Objectives: Cognitively impaired individuals are at increased risk for functional and behavioral difficulties at mealtimes, leading to compromised eating performance, low food and fluid intake, and negative functional and nutritional outcomes. Nursing assistants are the most critical front-line care staff and best positioned to manage the personal and environmental factors that influence resident eating performance. Identifying nursing assistants’ perceptions of barriers and facilitators to engaging residents in eating will provide important experientially based foundation for developing and testing evidence-driven interventions to promote mealtime care. Methods: A qualitative descriptive study was conducted in three sites: two nursing homes and one hospital gero-psychiatric inpatient unit. Six focus groups were conducted with a purposive sample of 23 nursing assistants who regularly provided mealtime care to residents with cognitive impairment. Interview questions addressed barriers and facilitators at resident, caregiver, environmental (facility), and policy levels in optimizing mealtime care. Audio recordings of focus groups were transcribed and analyzed using qualitative descriptive content analysis. Both barriers and facilitators were organized into a hierarchical taxonomy based on similarities and differences framed by the Social Ecological Model. Results: The majority of barriers and facilitators were at the caregiver level. Caregiver-level barriers included lack of preparation and training, competing work demands, time pressure, and frustration. Caregiver-level facilitators included caregiver preparation and motivational, technical, informational, and instrumental assistance. Environmental-level barriers and facilitators related to the physical, social, and cultural environment and facility practices. Only barriers to optimizing mealtime care were identified at resident and policy levels. Conclusions: Nursing assistants identified multilevel barriers as well as a wide range of caregiver and environmental facilitators to optimizing dementia mealtime care. Findings can inform the development and implementation of multifaceted innovative mealtime assistance and staff training programs to promote resident eating performance while fostering person-centered individualized mealtime care practice. (Edited publisher abstract)
Resource use and its association to cognitive impairment, ADL functions, and behavior in residents of Swedish nursing homes: results from the U‐Age program (SWENIS study)
- Authors:
- SKOLDUNGER Anders, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 34(1), 2019, pp.130-136.
- Publisher:
- Wiley
Objectives: To investigate resource use and its association to cognitive impairment, activities of daily living, and neuropsychiatric symptoms in residents of Swedish nursing homes. Methods: Data were collected in 2014 from a Swedish national sample of nursing home residents (n = 4831) and were collected by staff in the facility. The sample consists of all nursing homes in 35 of 60 randomly selected Swedish municipalities. Demographic data and data on resource use, cognitive and physical function as well as neuropsychiatric symptoms were collected through proxies. Descriptive statistics and regression modeling were used to investigate this association. Results: Cognitive impairment, activities of daily living, and neuropsychiatric symptoms were associated with 23 hours per week increase in total resource use versus cognitively intact persons. This was also the case for being dependent in activities of daily living. Being totally dependent increased the amount of resource use by 25 hours per week. The sex of a resident did not influence the resource use. Annual costs of resource use with no functional dependency were 359 685 SEK, and in severely cognitive impaired resident, the cost was 825 081 SEK. Conclusion: Being cognitively impaired as well as functionally dependent increases the resource use significantly in nursing homes. This has implications for differentiation of costs in institutional settings in health economic evaluations. (Edited publisher abstract)
"Interactive surfaces" technology as a potential tool to stimulate physical activity in psychogeriatric nursing home residents
- Authors:
- BRAUN Susy M., et al
- Journal article citation:
- Disability and Rehabilitation: Assistive Technology, 10(6), 2015, pp.486-492.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Purpose: This study aimed to determine whether and how psychogeriatric nursing home residents would respond to the interactive surfaces on the floor without receiving instructions and to determine how long residents would be physically active. Methods: The 'interactive surfaces' technology includes different graphic shapes that are projected through a beamer on a floor. The surfaces are 'activated' by a person’s movements in the area of the projection field, which is detected by an infrared camera. Every day for 1 h during an 11-day period one of seven different projections was shown. Spontaneous observed physical responses were counted, clustered and visualised in a tree diagram. Duration of physically responses was measured per session and during the total observation period of 11 h. Results: During 343 of 490 observations residents (n = 58) noticed the interactive surface and in 148 observations they engaged physically. In total, 4067 s (1 h, 7 min and 47 s) of physical activity were measured. Individual times that residents were active ranged from 3 to 415 s. Conclusions: Interactive surfaces technology may be a promising tool in psychogeriatric nursing home residents to stimulate physical activity. Further research is needed to assess its full potential. (Edited publisher abstract)
Alternate housing models for older people with disabilities: their clientele, structures and resources in relation to the quality of and satisfaction with care delivery
- Authors:
- DUBUC Nicole, et al
- Journal article citation:
- Ageing and Society, 34(9), 2014, pp.1575-1600.
- Publisher:
- Cambridge University Press
This paper reports on the study of a subsidy programme that was established in Quebec for alternate housing models (AHMs), which allows private and community organisations to offer housing services within the framework of a partnership with public health-care services. The research objectives were: (a) to compare how facility characteristics and services provided by AHMs and nursing homes (NHs) differ; (b) to examine the personal characteristics of residents living in AHMs; and (c) to compare residents with similar characteristics within AHMs and NHs in terms of unmet needs, quality of care, satisfaction with care and services, and psycho-social adaptation to the residence. A cross-sectional study was undertaken with individually matched groups to assess whether AHMs meet the needs of elders in a way similar to NHs. Overall, residents in both groups had moderate to severe levels of disability and about 60 per cent had mild to severe cognitive problems. While their general features were heterogeneous, the AHMs were more comfortable and homelike than the NHs. The quality of and satisfaction with care was appropriate in both settings, although AHMs performed better. Only one-quarter of residents in both settings, however, evidenced a good level of psycho-social adaptation to their residence. This partnership approach is a good strategy to provide a useful range of housing types in communities that can respond to the needs of elders with moderate to severe disabilities. (Publisher abstract)
Identifying elderly depression using the Depression Rating Scale as part of comprehensive standardised care assessment in nursing homes
- Authors:
- HUANG Yachien, CARPENTER Iain
- Journal article citation:
- Aging and Mental Health, 15(8), November 2011, pp.1045-1051.
- Publisher:
- Taylor and Francis
This study explored the benefits of using the Depression Rating Scale (DRS) as part of a standardised needs assessment in UK nursing homes to assess resident’s depression. Participants included 499 residents in nine nursing homes in south-east England who were assessed with a standardised assessment tool. A list of characteristics associated with depression was then examined using bivariate analysis and logistic regression. Findings revealed that 68% were not depressed and 32% might suffer from depression. Being never married, diagnosed of chronic obstructive pulmonary disease, feelings of pain, and trouble sleeping were significantly associated with reporting depression. The DRS had distinctive advantages for use in UK nursing homes where a majority of residents are cognitively impaired. The authors outline policy implications in improving care quality and management for older residents of nursing homes.
'I hate having nobody here. I'd like to know where they all are': can qualitative research detect differences in quality of life among nursing home residents with different levels of cognitive impairment?
- Authors:
- CAHILL Suzanne, DIAZ-PONCE Ana
- Journal article citation:
- Aging and Mental Health, 15(5), July 2011, pp.562-572.
- Publisher:
- Taylor and Francis
This paper examined whether similarities or differences existed in perceptions of quality of life (QOL) amongst nursing home (NH) residents with different levels of cognitive impairment (CI). Face-to-face interviews were held with 61 older people with a CI (13 mild, 20 moderate and 28 severe) living in Dublin based NHs. Four key themes of QOL were identified: social contact; attachment; pleasurable activities; and affect. Whilst some similarities existed between the three groups, findings revealed emerging differences, particularly between those with a mild and severe CI. Those with a severe CI reflected an absence of social contact, a quest for human contact and a lack of awareness of enjoyable activities. The majority also reported feelings of loneliness and isolation. Findings support the evidence that people with a CI and those advanced dementia can often still communicate their views and preferences about what is important to them. Whilst depression and anxiety are common in advanced dementia, the social inclusion of these people in day-to-day NH life needs a more careful consideration.
Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity
- Authors:
- ZUIDEMA Sytse, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(10), October 2009, pp.1079-1086.
- Publisher:
- Wiley
This study aimed to assess the influence of dementia severity and gender on neuropsychiatric symptoms in demented nursing home patients. It assessed a sample of Dutch nursing home patients using the Cohan-Mansfield Agitation Inventory and the Neuropsychiatric Inventory-Nursing Home version. The influence of gender and severity of cognitive decline, assessed with the Global Deterioration Scale (GDS), was investigated with correction for factors such as age, duration of institutionalisation, and psychoactive medication use. The results showed that while physically aggressive behaviour was more common in patients with very severe cognitive deterioration, disinhibition, irritability, physically non-aggressive and verbally agitated behaviour were more common in patients with moderately severe and severe cognitive decline. Physically aggressive behaviour was more common in men, whereas female patients demonstrated more verbally agitated behaviour. The study concluded that neuropsychiatric symptoms were associated with the severity of dementia, with most symptoms occurring in patients showing moderately severe cognitive decline, that only physical aggression, anxiety and apathy were more common in patients with very severe cognitive decline and that dementia severity and gender were important predictors of neuropsychiatric symptoms in this patient cohort.
Factors associated with depression in Norwegian nursing homes
- Authors:
- LAGE BARCA Maria, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(4), April 2009, pp.417-425.
- Publisher:
- Wiley
This study aimed to confirm or reject the hypothesis that depression in nursing homes is associated with worse medical health, cognitive and functional impairment. A sample of 902 randomly selected nursing-home patients was assessed using the Cornell Scale, the Clinical Dementia Rating Scale (CDR) the Self-Maintenance Scale and a general measurement of medical health. Additionally, information was collected from the patients' records. A multiple linear regression was performed with the Cornell Scale total score, and mood and non-mood subscale scores as the dependent variables. In the adjusted analysis, depression according to the Cornell total score was associated with worse medical health (strongest) and worse cognitive impairment, but not with worse functional impairment. The mood subscale score was associated with worse medical health, being unmarried and female gender, but not with worse cognitive impairment. The non-mood subscale score was correlated with cognitive impairment, worse medical health, younger age, digestive diseases and not having suffered from stroke. The hypothesis was partially confirmed. Worse general medical health was the strongest factor associated with depression, followed by degree of cognitive impairment. Cognitive impairment was not associated with the mood subscale score, but was the strongest correlate for the non-mood symptoms of the Cornell Scale.
Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents
- Authors:
- PAGUAY Louis, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(4), April 2007, pp.286-293.
- Publisher:
- Wiley
This study aimed to compare the diagnostic accuracy of an outcome measurement scale of the Minimum Data Set of the Resident Assessment Instrument for nursing homes (MDS/RAI-NH), the Cognitive Performance Scale (CPS) and the Mini-Mental State Exam (MMSE) for the detection of cognitive impairment. The Cambridge Examination for Mental Disorders of the Elderly - Revised (CAMDEX-R) was used as the reference standard. This study was part of a larger prospective study (QUALIDEM) involving a diagnostic procedure and two-year follow-up on the quality of primary care for demented patients. CAMDEX-R and MDS/RAI-NH were administered to 198 residents, aged 65 or more, living in 42 low and high care institutions for older people in Belgium. Main outcome measures used were indicators of diagnostic accuracy: sensitivity, specificity, predictive values, likelihood ratios, odds ratio and area under receiver operating characteristics curve (AUC). The CAMDEX-based prevalence of cognitive impairment was 75%. The results found that CPS and MMSE demonstrated similar performance to detect cognitive impairment in nursing home residents.