Dying at home in rural residential aged care: A mixed-methods study in the Snowy Monaro region, Australia

BACKGROUND Apathy is a common symptom in neurological disorders, including dementia, and is associated with a faster rate of cognitive decline, reduced quality of life, and high caregiver burden. There is a lack of effective pharmacological treatments for apathy, and nonpharmacological interventions are a preferred first-line approach to treatment. Virtual reality (VR) using head-mounted displays (HMDs) is being successfully used in exposure- and distraction-based therapies; however, there is limited research on using HMDs for symptoms of neurological disorders. OBJECTIVE This feasibility study aimed to assess whether VR using HMDs could be used to deliver tailored reminiscence therapy and examine the willingness to participate, response rates to measures, time taken to create tailored content, and technical problems. In addition, this study aimed to explore the immediate effects between verbal fluency and apathy after exposure to VR. METHODS A mixed methods study was conducted in a sample of older adults residing in aged care, and 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale (AES), and verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews to assess feedback from participants. Side effects that can occur from using HMDs were also measured. RESULTS We recruited participants from a high socioeconomic status setting with a high education level, and the participation rate was 85% (17/20); most responses to measures were positive. Access to a wide range of freely available content and the absence of technical difficulties made the delivery of a VR reminiscence intervention highly feasible. Participants had improved semantic scores (t14=−3.27; P=.006) but not phonemic fluency scores (t14=0.55; P=.59) immediately after the intervention. Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience, which was indicated by a strong positive relationship between the AES and semantic verbal fluency change scores postminus pre-VR (r=0.719; 95% CI 0.327 to 0.900; P=.003). All participants enjoyed the experience despite 35% (6/17) of participants experiencing temporary side effects. CONCLUSIONS This study provides initial evidence that it is feasible to use VR with HMDs for therapy to treat symptoms of apathy in older adults in residential aged care. However, there is a need to closely monitor the side effects of HMD use in older adults. Further research is needed using an active control group to compare the use of VR with traditional forms of reminiscence therapy.

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Palliative care Needs Rounds in rural residential aged care: A mixed-methods study exploring experiences and perceptions of staff and general practitioners

Progress in Palliative Care ◽

10.1080/09699260.2019.1698177 ◽

2019 ◽

Vol 28 (5) ◽

pp. 308-317

Author(s):

Suzanne Rainsford ◽

Nikki Johnston ◽

Wai-Man Liu ◽

Nicholas Glasgow ◽

Liz Forbat

Keyword(s):

Palliative Care ◽

Mixed Methods ◽

General Practitioners ◽

Aged Care ◽

Mixed Methods Study ◽

Residential Aged Care ◽

Care Needs ◽

Palliative Care Needs

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Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study

Journal of Medical Internet Research ◽

10.2196/17632 ◽

2020 ◽

Vol 22 (6) ◽

pp. e17632 ◽

Cited By ~ 2

Author(s):

Dimitrios Saredakis ◽

Hannah AD Keage ◽

Megan Corlis ◽

Tobias Loetscher

Keyword(s):

Older Adults ◽

Virtual Reality ◽

Mixed Methods ◽

Side Effects ◽

Neurological Disorders ◽

Verbal Fluency ◽

Aged Care ◽

Mixed Methods Study ◽

Residential Aged Care ◽

Reminiscence Therapy

Background Apathy is a common symptom in neurological disorders, including dementia, and is associated with a faster rate of cognitive decline, reduced quality of life, and high caregiver burden. There is a lack of effective pharmacological treatments for apathy, and nonpharmacological interventions are a preferred first-line approach to treatment. Virtual reality (VR) using head-mounted displays (HMDs) is being successfully used in exposure- and distraction-based therapies; however, there is limited research on using HMDs for symptoms of neurological disorders. Objective This feasibility study aimed to assess whether VR using HMDs could be used to deliver tailored reminiscence therapy and examine the willingness to participate, response rates to measures, time taken to create tailored content, and technical problems. In addition, this study aimed to explore the immediate effects between verbal fluency and apathy after exposure to VR. Methods A mixed methods study was conducted in a sample of older adults residing in aged care, and 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale (AES), and verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews to assess feedback from participants. Side effects that can occur from using HMDs were also measured. Results We recruited participants from a high socioeconomic status setting with a high education level, and the participation rate was 85% (17/20); most responses to measures were positive. Access to a wide range of freely available content and the absence of technical difficulties made the delivery of a VR reminiscence intervention highly feasible. Participants had improved semantic scores (t14=−3.27; P=.006) but not phonemic fluency scores (t14=0.55; P=.59) immediately after the intervention. Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience, which was indicated by a strong positive relationship between the AES and semantic verbal fluency change scores postminus pre-VR (r=0.719; 95% CI 0.327 to 0.900; P=.003). All participants enjoyed the experience despite 35% (6/17) of participants experiencing temporary side effects. Conclusions This study provides initial evidence that it is feasible to use VR with HMDs for therapy to treat symptoms of apathy in older adults in residential aged care. However, there is a need to closely monitor the side effects of HMD use in older adults. Further research is needed using an active control group to compare the use of VR with traditional forms of reminiscence therapy.

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Investigating the impact of a falls prevention community of practice in a residential aged-care setting: a mixed methods study protocol

Journal of Advanced Nursing ◽

10.1111/jan.12725 ◽

2015 ◽

Vol 71 (12) ◽

pp. 2977-2986 ◽

Cited By ~ 6

Author(s):

Jacqueline Francis-Coad ◽

Christopher Etherton-Beer ◽

Caroline Bulsara ◽

Debbie Nobre ◽

Anne-Marie Hill

Keyword(s):

Mixed Methods ◽

Community Of Practice ◽

Study Protocol ◽

Care Setting ◽

Aged Care ◽

Mixed Methods Study ◽

Falls Prevention ◽

Residential Aged Care ◽

The Impact

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“Consideration of patients as networked units to identify opportunities and motivation to enhance capability”: A mixed methods study to explore a personalised Digital Health Hub Model of Care for hip fractures in South Australia (Preprint)

10.2196/preprints.26886 ◽

2021 ◽

Author(s):

Lalit Yadav ◽

Tiffany K Gill ◽

Anita Taylor ◽

Jen DeYoung ◽

Mellick J Chehade

Keyword(s):

Hip Fractures ◽

Digital Health ◽

Family Members ◽

South Australia ◽

Aged Care ◽

Mixed Methods Study ◽

Residential Aged Care ◽

Model Of Care ◽

Factors Influencing

UNSTRUCTURED Introduction Majority of older people with hip fractures once admitted to acute hospital care are unable to return to their pre-fracture level of independence and a significant number are either newly admitted or return to residential aged care. Patient education involves family members and/or residential aged care staff as networked units, crucial for empowerment through improving health literacy. Advancement of digital technology has led to evolving solutions around optimising health care including self-management of chronic disease conditions and telerehabilitation. The aim of this study is to understand perspectives of older patients with hip fractures, their family members and residential aged carers, to inform the development of a digitally enabled model of care using a personalised digital health hub (pDHH). Methods A mixed methods study was conducted at a public tertiary care hospital in South Australia involving patients aged 50 years and above along with their family members and residential aged carers. Quantitative data, including basic demographic characteristics, access to computers and Internet were analysed using descriptive statistics. Spearman’s Rank Order Correlation was used to examine correlations between the perceived role of a pDHH in improving health and likelihood of subsequent usage. Whereas qualitative data included series of open-ended questions and findings were interpreted using constructs of capability, opportunity and motivation to help understand the factors influencing the likelihood of potential pDHH use Results Overall, 100 people were recruited in the study, representing 55 patients, 13 family members and 32 residential aged carers. The mean age of patients was 76.4 years (SD-8.4, age range 54-88) and females represented 60% of patients. Although a moderate negative correlation existed with increasing age and likelihood of pDHH usage (ρ= -0.50, p<0.001) the perceived role of the DHH in improving health had a strong positive correlation with the likelihood of pDHH usage by self (ρ=0.71, p<0.001) and by society, including friends and family members (ρ=0.75, p<0.001). Of particular note, almost all the patients (98%) believed they had a family member or friend /carer who would be able to help them to use a digital health platform. Whereas our qualitative findings suggest emphasising on complex interplay of capability, opportunity and motivation as crucial factors while designing a pDHH enabled model of care for hip fractures at a local context level. Conclusion Findings from this study contributed to understand the dynamics around capabilities, motivation and opportunities of patients, family members and formal carers as a “patient networked unit”. Future research recommendation must involve co-creation guided by iterative processes through improving understanding of factors influencing development and successful integration of complex digital healthcare interventions in real-world scenarios.

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Spiritual Factors in the Experience of Alzheimer's Disease and Other Dementias

Advances in Psychology, Mental Health, and Behavioral Studies - Psychosocial Studies of the Individual's Changing Perspectives in Alzheimer's Disease ◽

10.4018/978-1-4666-8478-2.ch010 ◽

2015 ◽

pp. 230-253

Author(s):

Elizabeth MacKinlay ◽

Corinne Trevitt

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Mixed Methods ◽

Cognitive Decline ◽

Later Life ◽

Aged Care ◽

Residential Aged Care ◽

Meaningful Life ◽

Diagnosis Of Dementia ◽

The Face

Alzheimer's disease and other dementias raise important questions of personhood and connection for those affected. Finding meaning in the face of dementia is one of the most challenging aspects of dementia; spiritual reminiscence is a way of connecting with those with dementia when their cognitive decline seems to preclude them from participating in a meaningful life. In this chapter a context for spirituality in later life is given through description of the spiritual tasks and process of ageing. This leads to presentation of work based on a mixed methods study of 113 people in residential aged care with a diagnosis of dementia who participated in either six or 24 weeks of weekly sessions of guided spiritual reminiscence (MacKinlay & Trevitt, 2012). Relationship was found to be almost synonymous with meaning for these people. Other important themes identified were vulnerability and transcendence, wisdom, hope, despair, and response to meaning.

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Spiritual Factors in the Experience of Alzheimer's Disease and Other Dementias

Religion and Theology ◽

10.4018/978-1-7998-2457-2.ch020 ◽

2020 ◽

pp. 334-357

Author(s):

Elizabeth MacKinlay ◽

Corinne Trevitt

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Mixed Methods ◽

Cognitive Decline ◽

Later Life ◽

Aged Care ◽

Residential Aged Care ◽

Meaningful Life ◽

Diagnosis Of Dementia ◽

The Face

Alzheimer's disease and other dementias raise important questions of personhood and connection for those affected. Finding meaning in the face of dementia is one of the most challenging aspects of dementia; spiritual reminiscence is a way of connecting with those with dementia when their cognitive decline seems to preclude them from participating in a meaningful life. In this chapter a context for spirituality in later life is given through description of the spiritual tasks and process of ageing. This leads to presentation of work based on a mixed methods study of 113 people in residential aged care with a diagnosis of dementia who participated in either six or 24 weeks of weekly sessions of guided spiritual reminiscence (MacKinlay & Trevitt, 2012). Relationship was found to be almost synonymous with meaning for these people. Other important themes identified were vulnerability and transcendence, wisdom, hope, despair, and response to meaning.

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