Can theory of mind of healthy older adults living in a nursing home be improved? A randomized controlled trial

Abstract Background Research in nursing homes mainly focused on interventions for residents affected by cognitive decline. Few studies have considered healthy older adults living in nursing homes, and this research targeted cognitive functioning. Aims To evaluate whether socio-cognitive abilities can be improved by means of a theory of mind (ToM) training conducted by nursing home’s operators. Methods Results Results revealed that older adults benefitted from the ToM intervention in both practiced and non-practiced tasks, while the control group showed no change from pre- to post-test evaluation. Analyses on errors scores indicated that the ToM intervention led to a reduction of both excessive mentalizing and absence of mental states inference. Discussion The conversation-based ToM intervention proved to be effective in improving socio-cognitive skills in cognitively healthy nursing home residents. Notably, older adults were able to transfer the skills acquired during the training to new material. Conclusions Promoting healthy resident’s ToM ability could positively impact on their social cognition, consequently increasing their quality of life. Our findings showed that the intervention can be feasibly managed by health care assistants within the residential context.

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A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial

International Psychogeriatrics ◽

10.1017/s1041610221000818 ◽

2021 ◽

pp. 1-13

Author(s):

Julie L. O’Sullivan ◽

Sonia Lech ◽

Paul Gellert ◽

Ulrike Grittner ◽

Jan-Niklas Voigt-Antons ◽

...

Keyword(s):

Quality Of Life ◽

Randomized Controlled Trial ◽

Nursing Home ◽

Nursing Homes ◽

Psychotropic Medication ◽

Controlled Trial ◽

Nursing Home Residents ◽

Randomized Controlled ◽

Cluster Randomized

Abstract Objectives: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. Design: Cluster-randomized controlled trial. Setting: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). Participants: N = 162 residents with dementia. Intervention: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. Measurements: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer’s Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. Results: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI −3.54, 2.33 for TBI and .36 points, 95% CI −3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen’s d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. Conclusions: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

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Improving Quality of Life in Nursing Homes: The Structured Resident Interview Approach

Journal of Aging Research ◽

10.1155/2014/892679 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Howard B. Degenholtz ◽

Abby L. Resnick ◽

Natalie Bulger ◽

Lichun Chia

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Nursing Homes ◽

Planning Process ◽

Intervention Group ◽

Nursing Home Residents ◽

Care Plan ◽

Control Group ◽

Improvement Programs

The quality of life (QOL) of the approximately 1.5 million nursing facility (NF) residents in the US is undoubtedly lower than desired by residents, families, providers, and policy makers. Although there have been important advances in defining and measuring QOL for this population, there is a need for interventions that are tied to standardized measurement and quality improvement programs. This paper describes the development and testing of a structured, tailored assessment and care planning process for improving the QOL of nursing home residents. The Quality of Life Structured Resident Interview and Care Plan (QOL.SRI/CP) builds on a decade of research on measuring QOL and is designed to be easily implemented in any US nursing home. The approach was developed through extensive and iterative pilot testing and then tested in a randomized controlled trial in three nursing homes. Residents were randomly assigned to receive the assessment alone or both the assessment and an individualized QOL care plan task. The results show that residents assigned to the intervention group experienced improved QOL at 90- and 180-day follow-up, while QOL of residents in the control group was unchanged.

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Effect of hypoxic conditioning on functional fitness, balance and fear of falling in healthy older adults: a randomized controlled trial

European Review of Aging and Physical Activity ◽

10.1186/s11556-021-00279-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Rafael Timon ◽

Marta Camacho-Cardeñosa ◽

Adrián González-Custodio ◽

Guillermo Olcina ◽

Narcis Gusi ◽

...

Keyword(s):

Older Adults ◽

Fear Of Falling ◽

Controlled Trial ◽

Training Group ◽

Training Programme ◽

Control Group ◽

Functional Fitness ◽

Healthy Older Adults ◽

Hypoxia Exposure ◽

Hypoxic Conditions

Abstract Background Hypoxic conditioning has been proposed as a new tool to mitigate the sarcopenia and enhance health-related function, but decrements in standing balance have been observed during hypoxia exposure. The aim of the study was to evaluate the effect of a hypoxic conditioning training on functional fitness, balance and fear of falling in healthy older adults. Methods A total of 54 healthy older adults (aged 65–75 years), who voluntarily participated in the study, were randomly divided into three groups: the control group (CON), the normoxia training group (NT) that performed strength training in normoxia, and the hypoxia training group (HT) that trained under moderate hypoxic conditions at a simulated altitude of 2500 m asl. The training programme that was performed during 24 weeks was similar in both experimental groups and consisted of a full-body workout with elastic bands and kettlebells (three sets × 12–15 reps). The Senior Fitness Test (SFT), the Single Leg Stance test (SLS) and the Short Falls Efficacy Scale-International (FES-I) were assessed before and after the intervention. Results Results showed that after training, either in normoxia or in hypoxia, the participants increased upper and lower body strength, and the aerobic endurance, and decreased the fear of falling. Conclusions The moderate hypoxic conditioning seems to be a useful tool to increase the functional capacity in healthy older adults without observing a decline in balance. Trial registration ClinicalTrials.gov NCT04281264. Registered February 9, 2019-Retrospectively registered.

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A Tablet ‐ Based Intervention for Activating Nursing Home Residents with Dementia: Results from a Cluster-Randomised Controlled Trial

10.21203/rs.3.rs-66724/v1 ◽

2020 ◽

Author(s):

Julie Lorraine O'Sullivan ◽

Sonia Lech ◽

Paul Gellert ◽

Ulrike Grittner ◽

Jan-Niklas Voigt-Antons ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Nursing Homes ◽

Primary Outcome ◽

Controlled Trial ◽

Nursing Home Residents ◽

Cluster Randomised Controlled Trial ◽

Post Intervention ◽

Randomised Controlled

Abstract Background: Non-pharmacological interventions (NPI) can improve cognitive and non-cognitive symptoms in nursing home residents living with dementia. However, delivery of suitable NPI can be challenging in everyday nursing home settings. Internet and communication technologies (ICT) may be promising tools for supporting NPI delivery in nursing homes. Methods: A two-arm cluster-randomised controlled trial was conducted to investigate global and momentary effects of a novel ICT-based NPI for nursing home residents with dementia. Ten nursing homes were randomly allocated to the tablet-based intervention (TBI) or conventional activity sessions (CAS) group (each with five nursing homes) between April 2016 and May 2017. A total of N = 162 participants received either regular TBI (n = 80) or CAS (n = 82) over a period of eight weeks. Linear mixed models were used to analyse group differences regarding the primary outcome apathy (AES-I), and secondary outcomes quality of life (QOL-AD, QUALIDEM), neuropsychiatric (NPI-NH, psychotropic medication) and depressive symptoms (GDS). Ecological Momentary Assessments (EMA) of quality of life were also conducted in both groups before and after each activity session.Results: No significant group difference in the change of apathy (AES-I score, primary outcome) was found post intervention (mean group difference: B = .19; 95% CI: -3.90 to 4.28, p = .93). Regarding secondary outcomes, a reduction of psychotropic medication was found for TBI compared to CAS (B = .42; 95% CI: .15 to .69, p < .01). Further analyses revealed a post-intervention improvement of informant-rated quality of life across both groups (B = 3.69; 95% CI: .68 to 6.69, p = .02). Analysis of EMA also rendered short-term post-session improvements of quality of life in the CAS group (B = .43; 95% CI: .30 to .57, p < .001). Conclusions: These findings suggest that NPI involving individually tailored activities have a beneficial impact on quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, ICT have the potential to support NPI delivery and facilitate regular assessments of fluctuating momentary states in nursing home residents with dementia. Trial registration: The trial was retrospectively registered with the ISRCTN registry (Trial registration number: ISRCTN98947160) on 01/09/2016 http://www.isrctn.com/ISRCTN98947160.

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No Other Safe Care Option: Nursing Home Admission as a Last Resort Strategy

The Gerontologist ◽

10.1093/geront/gnaa077 ◽

2020 ◽

Vol 60 (8) ◽

pp. 1504-1514

Author(s):

Heather J Campbell-Enns ◽

Megan Campbell ◽

Kendra L Rieger ◽

Genevieve N Thompson ◽

Malcolm B Doupe

Keyword(s):

Older Adults ◽

Nursing Home ◽

Nursing Homes ◽

Nursing Home Residents ◽

Community Setting ◽

Nursing Home Admission ◽

Care Needs ◽

Community Based ◽

Field Notes ◽

Care Nursing

Abstract Background and Objectives Nursing homes are intended for older adults with the highest care needs. However, approximately 12% of all nursing home residents have similar care needs as older adults who live in the community and the reasons they are admitted to nursing homes is largely unstudied. The purpose of this study was to explore the reasons why lower-care nursing home residents are living in nursing homes. Research Design and Methods A qualitative interpretive description methodology was used to gather and analyze data describing lower-care nursing home resident and family member perspectives regarding factors influencing nursing home admission, including the facilitators and barriers to living in a community setting. Data were collected via semistructured interviews and field notes. Data were coded and sorted, and patterns were identified. This resulted in themes describing this experience. Results The main problem experienced by lower-care residents was living alone in the community. Residents and family members used many strategies to avoid safety crises in the community but experienced multiple care breakdowns in both community and health care settings. Nursing home admission was a strategy used to avoid a crisis when residents did not receive the needed support to remain in the community. Discussion and Implications To successfully remain in the community, older adults require specialized supports targeting mental health and substance use needs, as well as enhanced hospital discharge plans and improved information about community-based care options. Implications involve reforming policies and practices in both hospital and community-based care settings.

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A randomized controlled trial of a specific reminiscence approach to promote the well-being of nursing home residents with dementia

International Psychogeriatrics ◽

10.1017/s1041610204000055 ◽

2004 ◽

Vol 16 (1) ◽

pp. 33-49 ◽

Cited By ~ 80

Author(s):

Claudia K. Y. Lai ◽

Iris Chi ◽

Jeanie Kayser-Jones

Keyword(s):

Randomized Controlled Trial ◽

Nursing Home ◽

Repeated Measures ◽

Comparison Group ◽

Controlled Trial ◽

Intervention Group ◽

Nursing Home Residents ◽

Well Being ◽

Control Group ◽

Randomized Controlled

Background: To date, no firm conclusions can be reached regarding the effectiveness of reminiscence for dementia. Researchers have emphasized that there is an urgent need for more systematic research in the area.Objective and Method: A single-blinded, parallel-groups (one intervention, one comparison, and one no-intervention group) randomized controlled trial (RCT) was adopted to investigate whether a specific reminiscence program leads to higher levels of psychosocial well-being in nursing home residents with dementia. The intervention adopted a life-story approach, while the comparison group provided friendly discussions to control for any changes in outcome as a result of social contacts and attention. The Social Engagement Scale (SES) and Well-being/Ill-being Scale (WIB) were the outcome measures used. The outcomes of the groups were examined with reference to the baseline (T0), immediately (T1), and six weeks (T2) after intervention. The final sample had 101 subjects (control group: n=30; comparison group: n=35; intervention group: n=36). Using multivariate analysis with repeated measures, no significant differences in outcome were found between groups at either T1 or T2. Wilcoxon signed rank tests were performed for each group comparing outcomes between T1 and T0, T2 and T1, and T2 and T0. Significant differences were observed in the intervention group when comparing T1 and T0 WIB (p=.014), but not for the other groups.Conclusion: Although the intervention did not lead to significant differences between the three groups over time, there was a significant improvement in psychosocial well-being for the intervention group.

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Can leisure activities slow dementia progression in nursing home residents? A cluster-randomized controlled trial

International Psychogeriatrics ◽

10.1017/s1041610213002524 ◽

2014 ◽

Vol 26 (4) ◽

pp. 637-643 ◽

Cited By ~ 15

Author(s):

Sheung-Tak Cheng ◽

Pizza K. Chow ◽

You-Qiang Song ◽

Edwin C. S. Yu ◽

John H. M. Lam

Keyword(s):

Nursing Home ◽

Tai Chi ◽

Controlled Trial ◽

Nursing Home Residents ◽

Control Group ◽

Multilevel Regression ◽

Global Functioning ◽

Gradual Improvement ◽

Cluster Randomized ◽

Functional Components

ABSTRACTBackground:To examine the effects of complex cognitive (mahjong) and physical (Tai Chi) activities on dementia severity in nursing home residents with dementia.Methods:Cluster-randomized open-label controlled design. 110 residents were randomized by nursing home into three conditions: mahjong, Tai Chi, and simple handicrafts (control). Activities were conducted three times a week for 12 weeks. Clinical Dementia Rating (CDR) was taken at 0 (baseline), 3 (post-treatment), 6, and 9 months. The outcome measure was CDR sum-of-box, which is a composite measure of both cognitive and functional deterioration in dementia.Results:Intent-to-treat analyses were performed using multilevel regression models. Apolipoprotein E ε4 allele and education were included as covariates. Neither treatments had effects on the cognitive and functional components of the CDR, but mahjong had a significant interaction with time on the CDR sum-of-box total, suggesting a slower rate of global deterioration in the mahjong group as compared with the control group.Conclusions:Mahjong led to a gradual improvement in global functioning and a slightly slower rate of dementia progression over time. The effect was generalized and was not specific to cognition or daily functioning.

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Comparison of the Microbiota of Older Adults Living in Nursing Homes and the Community

mSphere ◽

10.1128/msphere.00210-17 ◽

2017 ◽

Vol 2 (5) ◽

Cited By ~ 12

Author(s):

Mary-Claire Roghmann ◽

Alison D. Lydecker ◽

Lauren Hittle ◽

Robert T. DeBoy ◽

Rebecca G. Nowak ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Nursing Home ◽

Nursing Homes ◽

Relative Abundance ◽

Bacterial Communities ◽

Nursing Home Residents ◽

The Body ◽

Health Care Environment ◽

The Past

ABSTRACT The nose, throat, and skin over the subclavian and femoral veins are the body sites which harbor the bacteria which most commonly cause health care-associated infection. We assessed the effect of nursing home residence on the microbiota of these body sites in older adults. We found that the microbiota composition of the different body sites was similar between nursing home and community participants, but we identified differences in relative abundance levels. We found remarkable similarities in the bacterial communities of different body sites in older adults who lived in nursing homes compared to those in the community among people who had not been on antibiotics for the past 3 months. We also found that the femoral skin microbiota had evidence of stool contamination in the nursing home residents, providing a rationale for improved skin hygiene. Taken together, it appears that the health care environment does not alter the microbiota to the extent that antibiotics do. Our objective for this study was to characterize the microbial communities of the anterior nares (nose), posterior pharynx (throat), and skin of the femoral and subclavian areas in older adults from nursing homes and the community. Older adults (≥65 years) without antibiotic use for the past 3 months were recruited from nursing homes (NH; n = 16) and from the community (CB; n = 51). Specimens were taken from nose, throat, and skin sites for culture and bacterial profiling using 16S rRNA gene sequencing. We found that pathogenic Gram-negative rod (GNR) colonization on the femoral skin was higher in NH participants than CB participants; otherwise, there were no differences in GNR colonization at other body sites or in Staphylococcus aureus colonization at any body site. Bacterial community profiling demonstrated that the operational taxonomic unit compositions of the different body sites were similar between NH and CB participants, but the analysis identified differences in relative abundance levels. Streptococcus spp. were more abundant and Prevotella spp. were less abundant in the throats of NH participants than in throats of CB participants. Proteus, Escherichia coli, and Enterococcus were more abundant in NH participants on the femoral skin. We found a pattern of decreased abundance of specific Proteobacteria in NH participants at the anterior nares and at both skin sites. We concluded that bacterial communities were largely similar in diversity and composition within body sites between older adults without recent antibiotic use from NH compared to those from the community. Our findings support the rationale for improved hygiene in NH residents to reduce the transmission risk of antibiotic-resistant bacteria, such as Enterococcus spp. or Enterobacteriaceae. IMPORTANCE The nose, throat, and skin over the subclavian and femoral veins are the body sites which harbor the bacteria which most commonly cause health care-associated infection. We assessed the effect of nursing home residence on the microbiota of these body sites in older adults. We found that the microbiota composition of the different body sites was similar between nursing home and community participants, but we identified differences in relative abundance levels. We found remarkable similarities in the bacterial communities of different body sites in older adults who lived in nursing homes compared to those in the community among people who had not been on antibiotics for the past 3 months. We also found that the femoral skin microbiota had evidence of stool contamination in the nursing home residents, providing a rationale for improved skin hygiene. Taken together, it appears that the health care environment does not alter the microbiota to the extent that antibiotics do.

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Nurse-Patient Interaction: A Vital Salutogenic Resource in Nursing Home Care

Health Promotion in Health Care – Vital Theories and Research ◽

10.1007/978-3-030-63135-2_10 ◽

2021 ◽

pp. 117-136

Author(s):

Gørill Haugan

Keyword(s):

Older Adults ◽

Health Promotion ◽

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Nursing Home Residents ◽

Nursing Home Care ◽

Patient Interaction ◽

Health Promoting ◽

To Come

AbstractWe are now witnessing a major change in the world’s population. Many people globally grow very old: 80, 90, and 100 years. Increased age is followed by an increased incidence of functional and chronic comorbidities and diverse disabilities, which for many leads to the need for long-term care in a nursing home. Quality of life and health promotive initiatives for older persons living in nursing homes will become ever more important in the years to come. Therefore, this chapter focuses on health promotion among older adults living in nursing homes. First, this chapter clarifies the concepts of health, salutogenesis, and pathogenesis, followed by knowledge about health promotion. Then insight and knowledge about the nursing home population is provided; what promotes health and well-being in nursing home residents?Health promotion in the health services should be based on integrated knowledge of salutogenesis and pathogenesis. The salutogenic understanding of health is holistic and considers man as a wholeness including physical, mental, social, and spiritual/existential dimensions. Research indicates that various health-promoting interventions, specifically the nurse–patient interaction, influence on older adults in nursing homes as a wholeness of body–soul–spirit, affecting the whole being. Hence, dimensions such as pain, fatigue, dyspnea, nausea, loneliness, anxiety, and depressive symptoms will be influenced through health-promoting approaches. Therefore, two separate studies on the health-promoting influences of nurse–patient interaction in nursing home residents were conducted. In total, nine hypotheses of directional influence of the nurse–patient interaction were tested, all of which finding support.Along with competence in pain and symptom management, health-promoting nurse–patient interaction based on awareness and attentional skills is essential in nursing home care. Thus, health care workers should be given the opportunity to further develop their knowledge and relational skills, in order to “refine” their way of being present together with residents in nursing homes. Health professionals’ competence involves the “being in the doing”; that is, both the doing and the way of being are essential in health and nursing care.

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Improvement of Cognitive Function after Physical Movement Training in Institutionalized Very Frail Older Adults with Dementia

GeroPsych ◽

10.1024/1662-9647/a000048 ◽

2011 ◽

Vol 24 (4) ◽

pp. 197-208 ◽

Cited By ~ 14

Author(s):

Franka Thurm ◽

Andrea Scharpf ◽

Nadine Liebermann ◽

Stephan Kolassa ◽

Thomas Elbert ◽

...

Keyword(s):

Older Adults ◽

Nursing Home Residents ◽

Control Group ◽

Cognitive Deterioration ◽

Physical Frailty ◽

Short Term ◽

Healthy Older Adults ◽

Positive Effects ◽

Movement Training ◽

Sum Score

Physical exercise has positive effects on cognitive functioning in both healthy older adults and ambulatory older adults with dementia. The present study investigated whether a 10-week multimodal movement intervention conducted in the seated position can slow cognitive deterioration in demented and physically very frail nursing-home residents. Our analysis revealed that training participants showed no further overall cognitive deterioration throughout the study and a significant improvement in the ADAS-Cog orientation/praxis subscore (p = .04). In contrast, the control group demonstrated a significant decline in the ADAS-Cog sum score (p = .02). These results might be of relevance for geriatric practice since they indicate that a short-term physical intervention – even in the seated position – can decelerate cognitive decline and dementia despite physical frailty.

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