Mechanisms of impact and contextual aspects of a dementia special care unit in long-term care: a process evaluation

Abstract Background In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to care concepts. Little information is available on how these facilities and care concepts bring about changes in the targeted outcomes. Such knowledge is needed to understand the effects of care concepts and to consciously shape further developments. This study aimed to explore the mechanisms of impact of a specific care concept from a dementia special care unit and the contextual aspects that influence its implementation or outcomes. Methods Using a qualitative approach to process evaluation of complex interventions, we conducted participating observations and focus groups with nurses and single interviews with ward and nursing home managers. Data were collected from two identical dementia special care units to enhance the contrasts in the analysis of two non-specialised nursing homes. We analysed the data thematically. We conducted 16 observations, three group interviews and eleven individual interviews. Results We identified seven themes in three domains related to mechanisms that lead to outcomes regarding residents’ and nurses’ behaviour and well-being. The themes include the development of nurses’ skills and knowledge, the promotion of a positive work climate, adjusted spatial structures, adjusted personnel deployment strategy “dedicated time for activities”, promotion of relaxation, of engagement in activities and of engagement in social interaction of residents. The implementation and outcomes of the care concept are influenced by contextual aspects relating to the (target) population and cultural, organisational and financial features. Conclusions The study found expected and unexpected mechanisms of impact and contextual aspects. The care concept of the dementia special care unit results in higher levels of relaxation, activities, and social interaction of residents. Its implementation highly depends on the shared understanding of nursing and the skills of the nursing team. Changes in residents’ characteristics result in altered effects of the concept. Trial registration DRKS00011513.

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Mechanisms Of Impact And Contextual Aspects of A Care Concept From A Dementia Special Care Unit In Long-Term Care: Process Evaluation As Part of A Theory-Driven Evaluation

10.21203/rs.3.rs-557180/v1 ◽

2021 ◽

Author(s):

Laura Adlbrecht ◽

Sabine Bartholomeyczik ◽

Hanna Mayer

Keyword(s):

Social Interaction ◽

Process Evaluation ◽

Long Term Care ◽

Complex Interventions ◽

Well Being ◽

Special Care ◽

Care Process ◽

Special Care Unit ◽

Term Care

Abstract Background: In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to their design and care concepts. Little information is available on how these facilities and care concepts bring about changes in the targeted outcomes. Such knowledge is needed to understand the effects of care concepts and to consciously shape further developments. This study aimed to explore the mechanisms of impact of a specific care concept from a dementia special care unit and the contextual aspects that influence its implementation or outcomes.Methods: Using a qualitative approach to process evaluation of complex interventions, we conducted participating observations and focus groups with nurses and single interviews with ward and nursing home managers. Data were collected from two identical dementia special care units to enhance the contrasts in the analysis of two non-specialised nursing homes. We analysed the data thematically. We conducted 16 observations, three group interviews and eleven individual interviews.Results: We identified seven themes in three domains related to mechanisms that lead to outcomes regarding residents’ and nurses’ behaviour and well-being. The development of nurses' skills and knowledge changes team-level competence and leads to an altered understanding of nursing. The promotion of a positive work climate reduces distress and promotes the long-term implementation of the care concept. Adjusted spatial structures and personnel strategies facilitate the implementation of interventions for residents and promote the fulfilment of their needs. Personalised psychosocial interventions promote residents' relaxation, engagement in activities and social interaction and thereby empower them to become part of the social community, to spend their time purposefully, to have positive experiences and to experience belonging and affection. The implementation and outcomes of the care concept are influenced by contextual aspects relating to the (target) population and cultural, organisational and financial features.Conclusions: The care concept of the dementia special care unit results in higher levels of relaxation, activities, and social interaction of residents. Its implementation highly depends on the shared understanding of nursing and the skills of the nursing team. Changes in residents’ characteristics result in altered effects of the concept.Trial registration: DRKS00011513

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Why so Little Interest in Whether or Not Old People Talk: A Review of Recent Research on Verbal Communication among the Elderly

The International Journal of Aging and Human Development ◽

10.2190/12x2-2rt6-mp4m-jhgu ◽

1979 ◽

Vol 9 (3) ◽

pp. 237-245 ◽

Cited By ~ 19

Author(s):

Rosemary B. Lubinski

Keyword(s):

Social Interaction ◽

Long Term Care ◽

Chronically Ill ◽

Well Being ◽

The Elderly ◽

Old People ◽

Term Care ◽

Vital Component ◽

Fertile Area

This paper is concerned with the spoken communication of chronically ill and aging residents of long term care institutions. Social gerontologists and speech pathologists have investigated areas related to spoken communication, however, there has been almost no investigation of communication from the patients' and staff perspective. Spoken communication is a vital component of social interaction and psychological well being and underlies such concepts as isolation, integration, and adjustment, and is a fertile area for investigation and analysis.

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Sociolinguistic Markers of Friendship Among Persons With Dementia in Long-Term Care

Innovation in Aging ◽

10.1093/geroni/igaa057.1911 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 575-575

Author(s):

Pamela Saunders

Keyword(s):

Social Interaction ◽

Long Term Care ◽

Ethnographic Study ◽

Linguistic Features ◽

Term Care ◽

Socially Constructed ◽

Time Period ◽

Pronominal Reference ◽

Field Notes

Abstract Sociolinguistics and discourse analysis provide tools through which to examine how friendship is socially constructed through language and communication. Research on social isolation and loneliness reveals the importance of social interaction on the psychological and physical health of older adults. Given that linguistic, communicative, and functional abilities decline as dementia progresses, it is challenging to identify markers of friendship. The Friendship Project is an ethnographic study of social interaction among persons with dementia living in a long-term care setting. The data are from transcripts and field-notes of social interactions among residents with a range of cognitive impairments over a six-month time period. Results reveal that persons with dementia employ specific linguistic features such as narrative, evaluation, evidentials, and pronominal reference to make meaning and create relationships over time. Practical implications will be discussed.

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Mental well‐being of staff in long‐term care facilities at risk

Geriatrics and Gerontology International ◽

10.1111/ggi.14260 ◽

2021 ◽

Author(s):

Chiaki Ura ◽

Tsuyoshi Okamura ◽

Akinori Takase ◽

Masaya Shimmei ◽

Yukan Ogawa

Keyword(s):

At Risk ◽

Long Term Care ◽

Well Being ◽

Term Care ◽

Care Facilities ◽

Mental Well Being

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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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Informal carer in Portugal: moving towards political recognition in Portugal

European Journal of Public Health ◽

10.1093/eurpub/ckz187.178 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

I Fronteira ◽

J Simoes ◽

G Augusto

Keyword(s):

Informal Care ◽

Long Term Care ◽

Well Being ◽

Oecd Countries ◽

Low Fertility ◽

Informal Carer ◽

Term Care ◽

System Perspective ◽

Informal Carers

Abstract Informal care represents around 80% of all long term care provided in EU countries. Nevertheless, the needs for this type of care are expected to increase in the coming years in all OECD countries. Portugal is among the OECD countries with the highest ageing index (21.5% of the population was older than 65 years in 2017) due to high life expectancy and low fertility rates. As this demographic trend establishes, Portugal is expected to have more than 40% of the population over 65 years in 2037, and the expected prevalence of dementia is 3%, in 2050. In 2015 there were 2.1% of people over 65 receiving long-term care, representing 52% of all long-term care users. Around 38% were receiving care at home. It is estimated that 287,000 people in Portugal depend on informal carers. The agenda towards the official recognition of informal cares has been push forward in the country. Since 2015, several recommendations have been issued by the Parliament as well as legislative initiatives and a proposal for a Status of the Informal Carer is currently under discussion. We analyse the process of formulation of this policy in terms of sectors and stakeholders involved, definition and scope of informal carer, rights and obligations, role of the person being cared for, formal protection (e.g., labor, social, financial, training) and implementation. Recognition of the informal carer is a sector wide approach. One of the main features is the economic, social and labor protection mainly through reconciliation between work life and caring activities and promotion of the carer’s well being. Notwithstanding, and from a health system perspective, community health teams are to be the focal point for informal carers, supporting and providing specific training whenever needed. Despite its relevance, informal care should not be professionalized and responsibility of care should not be shifted from health services to informal carers. Key messages Needs for informal care are expected to increase in the coming years in OECD countries. Recognition of the informal carer is a sector wide approach.

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#MoreThanAVisitor: Families as “Essential” Care Partners During COVID-19

The Gerontologist ◽

10.1093/geront/gnaa161 ◽

2020 ◽

Author(s):

Candace L Kemp

Keyword(s):

Family Involvement ◽

Long Term Care ◽

Research Policy ◽

Well Being ◽

Direct Care ◽

Negative Consequences ◽

Public Health Response ◽

Term Care ◽

Care Partners

Abstract The public health response to the current Coronavirus pandemic in long-term care communities, including assisted living, encompasses prohibiting visitors. This ban, which includes family members, has been criticized for being unfair, unhealthy, and unsafe. Against this backdrop, I examine the roles family play in residents’ daily lives and care routines. I argue that classifying family as “visitors” rather than essential care partners overlooks their critical contributions and stems from taken-for-granted assumption about gender, families, and care work, and I demonstrate why families are more than visitors. Policies that ban family visits also reflect a narrow understanding of health that focuses on mitigating infection risk, but neglects overall health and well-being. This policy further stems from a limited comprehension of care relations. Research shows that banning family visits has negative consequences for residents, but also families themselves, and direct care workers. I argue that identifying ways to better understand and support family involvement is essential and demonstrate the utility of the Convoys of Care model for guiding the reconceptualization of family in long-term care research, policy, and practice during and beyond the pandemic.

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FEDERAL POLICY SUPPORTS AND GAPS IN ADDRESSING RACIAL-ETHNIC HEALTH DISPARITIES IN U.S. LONG-TERM CARE FACILITIES

Innovation in Aging ◽

10.1093/geroni/igz038.576 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S161-S161

Author(s):

Rebecca L Mauldin ◽

Kathy Lee ◽

Antwan Williams

Keyword(s):

Long Term Care ◽

Federal Policy ◽

Care Facility ◽

Well Being ◽

The United States ◽

Term Care ◽

Long Term Care Facility ◽

Care Facilities

Abstract Older adults from racial and ethnic minority groups face health inequities in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. In spite of federal policy to support minority health and ensure the well-being of long-term care facility residents, disparities persist in residents’ quality of care and quality of life. This poster presents current federal policy in the United States to reduce racial and ethnic health disparities and to support long-term care facility residents’ health and well-being. It includes legislation enacted by the Patient Protection and Affordable Care Act of 2010 (ACA), regulations of the U.S. Department of Health and Human Services (DHHS) for health care facilities receiving Medicare or Medicare funds, and policies of the Long-term Care Ombudsman Program. Recommendations to address threats to or gaps in these policies include monitoring congressional efforts to revise portions of the ACA, revising DHHS requirements for long-term care facilities staff training and oversight, and amending requirements for the Long-term Care Ombudsman Program to mandate collection, analysis, and reporting of resident complaint data by race and ethnicity.

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