Social Connectivity in the Context of COVID-19 and Long-Term Care

Abstract The COVID-19 pandemic has disproportionately impacted older adults, particularly those residing in long-term care homes (LTCHs), causing immense loss of life and resulting in overall health declines in LTCH residents. These vulnerable older adults have also experienced extreme loneliness, anxiety and depression. Social connectedness is an important contributor to well-being and quality of life of older adults in LTCHs and family members are an essential component to this. However, restrictions driven by policies to protect resident safety, have constrained family members’ access to long-term care homes and limited in-person contact between residents and their families. In their absence, health providers have been integral to supporting connections between residents and their families within LTCHs. This study aimed to understand the experiences of social connectedness between residents and family members who have been physically separated due to the current pandemic and, to examine LTCH health providers’ experiences and responses to support social connectedness. Using a qualitative descriptive design, in-depth semi-structured interviews were conducted with 21 family members and 11 healthcare providers. Emergent themes from qualitative content analysis are: (a) all-encompassing impacts of separation; (b) advocacy became my life; (c) the emotional toll of the unknown; 4) the burden of information translation; 5) precarious balance between safety and mistrust for the healthcare system; and (d) a formulaic approach impedes connectivity. A more comprehensive understanding of the experiences and support needs of LTCH residents and their family members within the context of a pandemic can inform practice approaches to support social connections going forwards.

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Intimacy for older adults in long-term care: a need, a right, a privilege—or a kind of care?

Journal of Medical Ethics ◽

10.1136/medethics-2020-107171 ◽

2021 ◽

pp. medethics-2020-107171

Author(s):

Vanessa Schouten ◽

Mark Henrickson ◽

Catherine M Cook ◽

Sandra McDonald ◽

Nilo Atefi

Keyword(s):

Older Adults ◽

Long Term Care ◽

Family Members ◽

Well Being ◽

Cross Sectional Study ◽

Cross Sectional ◽

Term Care ◽

Survey Tool ◽

Whole Person

BackgroundTo investigate attitudes of staff, residents and family members in long-term care towards sex and intimacy among older adults, specifically the extent to which they conceptualise sex and intimacy as a need, a right, a privilege or as a component of overall well-being.MethodsThe present study was a part of a two-arm mixed-methods cross-sectional study using a concurrent triangulation design. A validated survey tool was developed; 433 staff surveys were collected from 35 facilities across the country. Interviews were conducted with 75 staff, residents and family members.ResultsIt was common for staff, residents and family members to talk about intimacy and sexuality in terms of rights and needs. As well as using the language of needs and rights, it was common for participants to use terms related to well-being, such as fun, happiness or being miserable. One participant in particular (a staff member) described receiving intimate touch as a ‘kind of care’—a particularly useful way of framing the conversation.ConclusionWhile staff, residents and family frequently used the familiar language of needs and rights to discuss access to intimate touch, they also used the language of well-being and care. Reframing the conversation in this way serves a useful purpose: it shifts the focus from simply meeting minimum obligations to a salutogenic approach—one that focuses on caring for the whole person in order to improve overall well-being and quality of life.

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Digital Technologies To Enhance Social Connectedness in Long-Term Care Facilities During COVID-19: A Review

Innovation in Aging ◽

10.1093/geroni/igaa057.3451 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 942-943

Author(s):

Shannon Freeman ◽

Aderonke Abgoji ◽

Alanna Koopmans ◽

Christopher Ross

Keyword(s):

Social Isolation ◽

Rural Areas ◽

Social Connectedness ◽

Long Term Care ◽

Care Facility ◽

Well Being ◽

Sufficient Information ◽

Term Care ◽

Care Facilities

Abstract A consequence of the strict visitor restrictions implemented by many Long-term Care Facilities (LTCFs), during the COVID-19 pandemic, was the exacerbation of loneliness and social isolation felt by older adult residents. While there had been a shift by some persons to utilize digital solutions to mitigate the effects of the imposed social isolation, many facilities did not have sufficient information regarding available solutions to implement institutional strategies to support social connectedness through digital solutions. To support our partners in evidence-based policy-making we conducted a scoping review to identify existing virtual technology solutions, apps, and platforms feasible to promote social connectedness among persons residing in a long-term care facility context during times of lockdown such as experienced during the COVID-19 pandemic. Initial identification of relevant literature involved a combination of keywords and subject headings searches within 5 databases (PubMed, CINAHL EBSCO, PsychINFO EBSCO, Embase OVIDSP, and Web of Science ISI). DistillerSR was used to screen, chart and summarize the data. There is growth in the availability of technologies focused on promoting health and well-being in later life for persons in long-term care facilities however a gap remains in widespread uptake. We will describe the breadth of technologies identified in this review and discuss how they vary in utility in smaller scale facilities common in rural areas. Of the technologies that can be used to mitigate the impacts of social isolation felt by long-term care residents, many “solutions” depend on stable highspeed internet, which remains a challenge in rural and northern areas.

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Hearing Screening for Residents in Long-Term Care Homes Who Live with Dementia: A Scoping Review

Journal of Alzheimer s Disease ◽

10.3233/jad-215087 ◽

2021 ◽

pp. 1-24

Author(s):

Fiona Höbler ◽

Katherine S. McGilton ◽

Walter Wittich ◽

Kate Dupuis ◽

Marilyn Reed ◽

...

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Nursing Staff ◽

Scoping Review ◽

Pure Tone ◽

Long Term Care ◽

Pure Tone Audiometry ◽

Care Homes ◽

Term Care

Background: Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed. Objective: To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs. Methods: Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O’Malley’s scoping review and appraisal process was followed. Results: There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs. Conclusion: Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.

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O2-07-04: DESIGNING FOR DEMENTIA: THE IMPACT OF INTERACTIVE AMBIENT TECHNOLOGY ON WELL-BEING IN LONG-TERM CARE HOMES

Alzheimer s & Dementia ◽

10.1016/j.jalz.2018.06.2678 ◽

2006 ◽

Vol 14 (7S_Part_11) ◽

pp. P636-P636

Author(s):

Andrea Wilkinson ◽

Mark Chignell ◽

Marc Kanik ◽

Judy O'Neill

Keyword(s):

Long Term Care ◽

Well Being ◽

Care Homes ◽

Term Care ◽

The Impact

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THE IMPACT OF A PARO INTERVENTION ON DEPRESSION AND WELL-BEING IN OLDER ADULTS WITH DEPRESSION

Innovation in Aging ◽

10.1093/geroni/igz038.1236 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S341-S341

Author(s):

Shu-Chuan Chen ◽

Wendy Moyle ◽

Cindy Jones

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Older People ◽

Long Term Care ◽

Well Being ◽

World Health ◽

Term Care ◽

Care Facilities

Abstract Aim: This study aimed to explore the effect of a social robot Paro intervention on depression and well-being in older adults with depression living in long-term care facilities in Taiwan. Methods: This study was adopted a single group and quasi-experimental with repeated measures design. Each participant participated in two stages: observation and Paro intervention stages. Stage 1 was an 8-week observation stage in long-term care facilities where the purpose was to observe the normal mood, behaviour and activities of older adults with depression. In stage 2, each participant was given a Paro by the researcher to keep for 24 hours for 7 days in for 8 weeks. Outcome measurements were obtained 4 times: a week before the intervention (T1), immediately the end of 8-week observation (T2), mid-point of Paro intervention (T3), and immediately the end of 8-week Paro intervention (T4). Instruments included the Geriatric Depression Scale, the UCLA Loneliness Scale version 3, and the World Health Organization Quality of Life Questionnaire-OLD. Results: There were 20 participants completed the study. The mean age of participants was 81.1years (SD = 8.2). After 8-week Paro intervention, statistically significant differences in changes were found on depression, loneliness, and quality of life from pre-intervention to post-intervention. Conclusion: This study was found that Paro intervention has beneficial effects on depression and mental well-being for older people with depression in long-term care facilities. Paro Intervention might be a suitable psychosocial intervention for older people with depression and should be considered as a useful tool in clinical practice.

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Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia

International Psychogeriatrics ◽

10.1017/s1041610211002675 ◽

2012 ◽

Vol 24 (5) ◽

pp. 753-765 ◽

Cited By ~ 18

Author(s):

Linda J. Garcia ◽

Michèle Hébert ◽

Jean Kozak ◽

Isabelle Sénécal ◽

Susan E. Slaughter ◽

...

Keyword(s):

Quality Of Life ◽

Focus Groups ◽

Long Term Care ◽

Disruptive Behaviors ◽

Well Being ◽

Care Homes ◽

Term Care ◽

Staff Members

ABSTRACTBackground: Disruptive behaviors are frequent and often the first predictor of institutionalization. The goal of this multi-center study was to explore the perceptions of family and staff members on the potential contribution of environmental factors that influence disruptive behaviors and quality of life of residents with dementia living in long-term care homes.Methods: Data were collected using 15 nominal focus groups with 45 family and 59 staff members from eight care units. Groups discussed and created lists of factors that could either reduce disruptive behaviors and facilitate quality of life or encourage disruptive behaviors and impede the quality of life of residents. Then each participant individually selected the nine most important facilitators and obstacles. Themes were identified from the lists of data and operational categories and definitions were developed for independent coding by four researchers.Results: Participants from both family and staff nominal focus groups highlighted facility, staffing, and resident factors to consider when creating optimal environments. Human environments were perceived to be more important than physical environments and flexibility was judged to be essential. Noise was identified as one of the most important factors influencing behavior and quality of life of residents.Conclusion: Specialized physical design features can be useful for maintaining quality of life and reducing disruptive behaviors, but they are not sufficient. Although they can ease some of the anxieties and set the stage for social interactions, individuals who make up the human environment are just as important in promoting well-being among residents.

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Mostly white, Christian, and straight: Informational and institutional erasure of LGBTQ and ethnoculturally diverse older adults on long-term care homes websites

Journal of Aging and Long-Term Care ◽

10.5505/jaltc.2019.69188 ◽

2019 ◽

Keyword(s):

Older Adults ◽

Long Term Care ◽

Care Homes ◽

Term Care

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HEALTH AND WELL-BEING OF OLDER ADULTS IN LONG-TERM CARE FACILITIES: LESSONS FROM LONGITUDINAL STUDIES.

Innovation in Aging ◽

10.1093/geroni/igz038.907 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S242-S242

Author(s):

Robert O Barker ◽

Andrew Kingston ◽

Fiona Matthews ◽

Barbara Hanratty

Keyword(s):

Older Adults ◽

Longitudinal Studies ◽

Long Term Care ◽

Well Being ◽

Cross Sectional ◽

Term Care ◽

Complex Needs ◽

People With Dementia ◽

Care Facilities

Abstract Older adults in long-term care facilities (LTCF) have complex needs for health care and support. There is a perception that residents’ needs are increasing over time, but little research evidence to back this up. In this study we brought together data on 1640 residents in LTCFs from three longitudinal studies, and conducted repeated cross-sectional analyses across a 25 year period. We found that the prevalence of severe disability amongst residents has increased from 56% to 80% over a 20 year period, driven by increases in difficulties in bathing and dressing. The prevalence of multimorbidity also increased from 29% to 56% between 2006 and 2014. A growth in the number of people with dementia, cardiovascular and cerebrovascular diseases contributed to this. We conclude that residents in LTCFs have become a selected subset of the population, characterised by increasing needs for support. This poses an important challenge for future care provision.

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Development and Field Testing of a Long-Term Care Decision Aid Website for Older Adults: Engaging Patients and Caregivers in User-Centered Design

The Gerontologist ◽

10.1093/geront/gnz141 ◽

2019 ◽

Vol 60 (5) ◽

pp. 935-946 ◽

Cited By ~ 3

Author(s):

Aubri S Hoffman ◽

Daniel R Bateman ◽

Craig Ganoe ◽

Sukdith Punjasthitkul ◽

Amar K Das ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Decision Aid ◽

Long Term Care ◽

Action Plan ◽

Family Members ◽

Field Testing ◽

Decisional Conflict ◽

Term Care

Abstract Background and Objectives Decisions about long-term care and financing can be difficult to comprehend, consider, and communicate. In a previous needs assessment, families in rural areas requested a patient-facing website; however, questions arose about the acceptability of an online tool for older adults. This study engaged older adults and family caregivers in (a) designing and refining an interactive, tailored decision aid website, and (b) field testing its utility, feasibility, and acceptability. Research Design and Methods Based on formative work, the research team engaged families in designing and iteratively revising paper drafts, then programmed a tailored website. The field test used the ThinkAloud approach and pre-/postquestionnaires to assess participants’ knowledge, decisional conflict, usage, and acceptability ratings. Results Forty-five older adults, family members, and stakeholders codesigned and tested the decision aid, yielding four decision-making steps: Get the Facts, What Matters Most, Consider Your Resources, and Make an Action Plan. User-based design and iterative storyboarding enhanced the content, personal decision-making activities, and user-generated resources. Field-testing participants scored 83.3% correct on knowledge items and reported moderate/low decisional conflict. All (100%) were able to use the website, spent an average of 26.3 min, and provided an average 87.5% acceptability rating. Discussion and Implications A decision aid website can educate and support older adults and their family members in beginning a long-term care plan. Codesign and in-depth interviews improved usability, and lessons learned may guide the development of other aging decision aid websites.

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