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Improving outcomes for residents in care homes: evidence briefing
- Author:
- IMPROVEMENT ACADEMY
- Publisher:
- Improvement Academy
- Publication year:
- 2016
- Pagination:
- 4
- Place of publication:
- Bradford
An overview of the evidence around optimising care to care home residents - to improve their health and well-being and to reduce the need for unscheduled care. Key messages for providers of care in care home are: offer staff training regarding recognition of cognitive states including delirium, supporting meaningful activity, end of life care; have clear processes in place for access to healthcare; provide information regarding dementia diagnosis and prognosis; ensure advance care planning takes place; offer opportunities to take part in meaningful activity. In addition, the briefing suggests that commissioners of old peoples’ services should: support the delivery of Comprehensive Geriatric Assessment (CGA); ensure broad involvement of stakeholders including care home providers and patients or representatives to ensure services are tailored; ensure service specifications include interventions such as cognitive reframing; ensure services are available and coordinated in relation to end of life care; ensure stable leadership and clear strategy of overall system; use of specific models of care can have benefit; do not neglect long term population strategies to support healthy ageing and prevent increasing disease burden; support the development of relationships between care homes and service providers, and ensure clear lines of responsibility; commission targeted training for staff; ensure evaluation and monitoring is fed back for continuous improvement. (Edited publisher abstract)
Systematic literature review on the conceptualisation of autonomy in the nursing home
- Author:
- FELDMANN A
- Publisher:
- University of Twente
- Publication year:
- 2020
- Pagination:
- 39
- Place of publication:
- Netherlands
(Master's thesis, University of Twente). Background: The basic psychological need of autonomy that was identified by the Self-Determination-Theory (SDT) as essential for wellbeing can be often hard to adopt for elderly residents in the environment of nursing homes. This review study constructs the concept of autonomy from the perspective of elderly nursing home residents to gain an understanding of what specifically characterises their autonomy-needs. Methods: A systematic literature review was used to qualitatively synthesise all study records found that provide self-reports of residents on autonomy (n = 15). Relevant themes as described by nursing home residents were identified and compared to the components of autonomy as defined within the SDT to evaluate whether the theory matches the needs of nursing home residents. Results and Conclusion: Five themes as part of the conceptualisation of autonomy by nursing home residents were identified: Choice and control, Independence, Freedom and resources, Being seen and heard and Chosen dependence and competence. These compare to the definition of autonomy within the SDT, which is taking variations in needs into consideration that match the perspectives of nursing home residents. The SDT definition of autonomy was specified here to set a basis for wellbeing interventions in nursing homes to increase resident autonomy. (Edited publisher abstract)
Prevalence and correlates of major depressive disorder, bipolar disorder and schizophrenia among nursing home residents without dementia: systematic review and meta-analysis
- Authors:
- FORNARO Michele, et al
- Journal article citation:
- British Journal of Psychiatry, 216(1), 2020, pp.6-15.
- Publisher:
- Cambridge University Press
Background: The elderly population and numbers of nursing homes residents are growing at a rapid pace globally. Uncertainty exists regarding the actual rates of major depressive disorder (MDD), bipolar disorder and schizophrenia as previous evidence documenting high rates relies on suboptimal methodology. Aims: To carry out a systematic review and meta-analysis on the prevalence and correlates of MDD, bipolar disorder and schizophrenia spectrum disorder among nursing homes residents without dementia. Method: Major electronic databases were systematically searched from 1980 to July 2017 for original studies reporting on the prevalence and correlates of MDD among nursing homes residents without dementia. The prevalence of MDD in this population was meta-analysed through random-effects modelling and potential sources of heterogeneity were examined through subgroup/meta-regression analyses. Results: Across 32 observational studies encompassing 13 394 nursing homes residents, 2110 people were diagnosed with MDD, resulting in a pooled prevalence rate of 18.9% (95% CI 14.8–23.8). Heterogeneity was high (I2 = 97%, P≤0.001); no evidence of publication bias was observed. Sensitivity analysis indicated the highest rates of MDD among North American residents (25.4%, 95% CI 18–34.5, P≤0.001). Prevalence of either bipolar disorder or schizophrenia spectrum disorder could not be reliably pooled because of the paucity of data. Conclusions: MDD is highly prevalent among nursing homes residents without dementia. Efforts towards prevention, early recognition and management of MDD in this population are warranted. (Publisher abstract)
What works in delivering effective enhanced primary care support in care homes?
- Author:
- CORDIS BRIGHT
- Publisher:
- Cordis Bright
- Publication year:
- 2018
- Pagination:
- 12
- Place of publication:
- London
Based on a review of the evidence, this briefing outlines the key elements to effective practice in delivering enhanced primary care and support in care homes to improve the quality of life and healthcare for residents. The briefing identifies some of the reasons for implementing enhanced primary care in care homes and the potential to improve outcomes. These include improved resident and care quality outcomes; beneficial impact on secondary care and community services; improved integration and partnership working; and cost benefits. It also outlines key supportive features and the barriers and limitations to delivering enhanced primary care in care homes. Three short case studies highlight three different models: a nurse-led model, a GP-led model, and a multi-disciplinary team model. (Edited publisher abstract)
Moving from a victim blaming to an appreciative inquiry: exploring quality of life in care homes
- Authors:
- MEYER Julienne, et al
- Journal article citation:
- Quality in Ageing, 7(4), December 2006, pp.27-36.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
This article highlights the need for researchers to work across disciplinary boundaries in order to capture the complexity that care practitioners have to engage with everyday in care home settings. Drawing on findings from a literature review on the complexity of loss in continuing care institutions for older people, the case is made for less victim blaming and more appreciative approaches to research. The way this thinking informed the development of a further literature review on quality of life in care homes is discussed. Findings from this second study are shared by illustrating key messages with quotes from older residents, relatives and staff living, visiting and working in care homes. These best practice messages focus on: transition into a care home; working to help residents maintain their identity; creating community within care homes; shared decision-making; health and health services; end-of-life care; keeping the workforce fit for purpose, and promoting positive culture. The importance of collaborative working in both research and practice is discussed.
Strategies and actions to enable meaningful family connections in nursing homes during the COVID-19: a scoping review
- Authors:
- VEIGA-SEIJO Raquel, MIRANDA-DURO Maria del Carmen, VEIGA-SEIJO Silvia
- Journal article citation:
- Clinical Gerontologist, 45(1), 2022, pp.20-30.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objectives: To better understand the impact of visitor restrictions on nursing home residents and their families as well as strategies and actions that were conducted in nursing homes during the COVID-19 pandemic. Methods: A scoping review was carried out in October 2020. Several electronic databases were used: Cochrane Plus, Scopus, Web of Sciences and PubMed. 725 results were identified. We included 10 articles. Results: Thematic analysis obtained the following categories: the impact of COVID-19 on nursing home residents’ lives and their families, procedures and frameworks of nursing homes during and after lockdown, and solutions and resources implemented by health care professionals to improve the connection between older people and their families. Conclusions: Visitor restrictions have a high impact on the health and well-being of older adults’ and their families. The main strategies and solutions employed to reduce social isolation and facilitate the communication between older adults’ and their families were the use of information and communication technologies, family support groups, and the assignment of reference staff to each family. Clinical implications: The strategies and solutions mentioned should be internationally considered by health care providers in nursing homes to improve connections between family and older adults. (Edited publisher abstract)
A scoping review: characteristics and outcomes of residents who experience involuntary relocation
- Authors:
- WEAVER Raven H., ROBERTO Karen A., BROSSOIE Nancy
- Journal article citation:
- Gerontologist, 60(1), 2020, pp.e20-e37.
- Publisher:
- Oxford University Press
Background and Objectives: Relocation to a residential care facility has been described as the most significant relocation affecting older adults, yet subsequent relocations, like in the case of a facility closure, have received minimal attention in the scholarly research literature. This paper reviews the published literature on involuntary relocation, focusing on the experiences of residents, families, and staff and the effects of involuntary relocation on nursing home residents’ health. Research Design and Methods: A scoping review was conducted to identify peer-reviewed studies reporting on involuntary relocation of nursing home residents. A total of 28 quantitative, qualitative, and mixed-method articles met inclusion criteria. Results: Researchers mostly relied on longitudinal designs and quantitative indicators of functional health, cognitive status, psychological and emotional well-being, environment, and relocation context to examine residents’ mortality risk and health outcomes associated with involuntary relocation. Inclusion of qualitative and mixed-method approaches was infrequent, as were indicators of social engagement and perceptions of relocation. Residents’ awareness of and preparation for involuntary relocation positively influenced their health and well-being. Family involvement was frequently hindered by communication challenges with facilities. Staff expressed concern about residents, experienced increased workload demands, and acknowledged challenges with planning and communication. Discussion and Implications: Based on the collective findings, the authors propose a conceptual model of critical factors at play during relocation for consideration for guiding future research and developing provisions to current policies guiding relocation processes. Facilities and policymakers need to consider procedures that enhance planning efforts and decision-making among this vulnerable population and their families. (Edited publisher abstract)
Intimacy between care home residents with dementia: findings from a review of the literature
- Authors:
- WISKERKE Esther, MANTHORPE Jill
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(1), 2019, pp.94-107.
- Publisher:
- Sage
Background: There is limited research on what family members and frontline care home staff consider to be the best responses to the sexual expression of a person with dementia, whilst at the same time respecting relatives’ feelings, managing their possible distress and conflict, and how good practice should be reflected in care home policy and practice guidance. Methods: This literature review explored what is known of the views of relatives and care workers of new relationships or sexual intimacy between care home residents with dementia, whilst still married to another person. It reports the findings of searches of three databases undertaken in August 2014 (Medline, Embase and PsychINFO). Findings: Nine papers were found relevant to the research question. The following themes emerged from a synthesis of the papers located: sexuality in old age, dementia and sexuality, hyper-sexuality, views regarding sexuality of older people living in care homes, the law, ethics and consent, relationships and communication between care home and relatives, and new relationships or intimacy between residents with dementia. Conclusion: While studies of residents’ expression of sexuality and their engaging in sexual behaviour with other resident(s) may be challenging to manage in care home settings and can be emotionally painful or uncomfortable for families, the review found that studies are few in number and span emotional intimacy and distressing behaviour. (Edited publisher abstract)