Aging

Collection of articles on Aging is available here.

Efficacy of Behavioral Interventions for Urinary Incontinence Among Women Residing in Nursing Homes: A Systematic Review.
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Allen LM, Nalley C, Devries AR, Fisher SR.
J Wound Ostomy Continence Nurs. 2023 Feb 1;50(1):57–65.
PURPOSE: The purpose of this systematic review was to summarize recent evidence on the efficacy of behavioral interventions for the management of urinary incontinence (UI) among women in nursing homes. METHODS: Systematic review of the literature. For this review, behavioral interventions were defined as those that included some form of physical exercise or behavior modification such as scheduled toileting. SEARCH STRATEGY: A search of MEDLINE/PubMed, CINAHL, Scopus, and Cochrane Library electronic databases was conducted seeking randomized controlled trials published since 2010 in female participants residing in long-term care facilities (nursing homes, skilled nursing facilities) and diagnosed with UI. Inclusion criteria were studies that addressed the effects of voiding regimens, lower extremity strengthening, functional training, food and fluid management, and pelvic floor muscle training. Independent reviewers extracted relevant data and assessed methodological quality using the PEDro scale. FINDINGS: Five studies (pooled sample, N = 399) met inclusion criteria; mean age of participants was 81.1 ± 6.8 years; 85% were female. The PEDro scores ranged from 6 to 9; only 2 studies included residents with cognitive impairment. Interventions included voiding strategies, increasing physical activity, functional mobility training, pelvic floor muscle training, fluid management, and multicomponent combinations of approaches. Three of the 5 studies were multicomponent interventions and 2 focused on a single intervention. Outcomes included objective measures of incontinent episodes and subjective assessments of UI severity. CONCLUSIONS: Behaviorally based interventions can be successful in improving UI among nursing residents with and with no cognitive impairment. IMPLICATIONS: Future studies should examine logistic and labor costs associated with sustaining behavioral interventions using nursing home staff and investigate the effects of these therapies using appropriate quality-of-life metrics for this population.

Osteosarcopenic Adiposity and Nutritional Status in Older Nursing Home Residents during the COVID-19 Pandemic.
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Cvijetić S, Keser I, Boschiero D, Ilich JZ.
Nutrients. 2023 Jan 1;15(1).
The aim was to evaluate body composition and prevalence of osteosarcopenic adiposity (OSA) in nursing home residents (NHR) and to assess their nutritional status. This research builds on our pilot study (conducted prior COVID-19 pandemic) that revealed high OSA prevalence and poor nutritional status in NHR. The current study included newly recruited n = 365 NHR; 296 women, 69 men, aged 84.3 ± 5.6 and 83.1 ± 7.3 years, respectively. Body composition was measured by bioelectrical impedance BIA-ACC(®), yielding total bone mass along with all components of lean and adipose tissues. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to assess nutritional status. Participants reported about their present/past diseases, including COVID-19. Mean duration of stay in nursing homes was 46.3 ± 47.0 months. Approximately 30% of participants had COVID-19 prior (median 6.7 months) to entering the study. OSA was diagnosed in 70.8% women and 47.8% men (p < 0.001). Malnourishment was detected in 5.8% women and 6.2% men while the risk of malnourishment was found in 30.8% women and 30.0% men. No significant differences in age, body composition parameters, prevalence of OSA, malnutrition/risk for malnutrition were found in participants who had COVID-19 compared to those who did not. Regression analysis showed that intramuscular adipose tissue (%) was significantly positively, while bone mass was significantly negatively associated with OSA. In this population, the high prevalence of OSA coincided with the high prevalence of malnutrition/risk of malnutrition. Such unfavorable body composition status is more likely a consequence of potentially poor diet quality in nursing homes, rather than of health hazards caused by COVID-19.

Integration of a new technology into a work system: a case study of a smart drinking glass in French nursing homes.
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Gazza C, Marcilly R, Kovacs B, Schiro J, Pelayo S.
Disabil Rehabil Assist Technol. 2023 Jan 9;1–13.
PURPOSE: To reduce the risk of dehydration in older adults, the French company Auxivia has developed a smart drinking glass (SDG) that can measure the amount of water drunk. The present study looked at the various work systems (WSs) designed for use of the SDG in a nursing home. The study’s objectives were to (i) determine the WSs’ impact on the staff’s ability to comply with the device’s prerequisites and ensure the device’s effective use and (ii) draw up guidelines on designing work systems. MATERIALS AND METHODS: At three nursing homes in France, two independent observers performed 9 h of observations at each site and a total of 29 interviews. RESULTS: Decisions concerning implementation and the resulting WSs have an impact on the tasks to be performed, the tasks’ inherent constraints and the use of the SDG. It is essential to take account of the sociotechnical system as a whole before integrating a technology. Ideally, the introduction of an SDG will go unnoticed by staff and residents; however, our results emphasize the value of highlighting work constraints via a human factors analysis. CONCLUSIONS: It is essential to take account of sociotechnical WSs as a whole when integrating a technology.Implications for rehabilitationFor caregivers, better measurement of the amount of water drunk by older adults might help to prevent dehydration.For service providers, better knowledge of how work systems influence the nursing home staff’s ability to comply with the smart drinking glass’s prerequisites might improve the device implementation process.For managers, a nursing home’s work systems should take account of the smart drinking glass’s prerequisites on one hand and the home’s environment and constraints on the other.

A Situation-Specific Theory of End-of-Life Communication in Nursing Homes.
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Gonella S, Campagna S, Dimonte V.
Int J Environ Res Public Health. 2023 Jan 3;20(1).
High-quality end-of-life communication between healthcare professionals (HCPs), patients and/or their family caregivers (FCs) improves quality of life and reduces non-beneficial care at the end of life. Nursing homes (NHs) are among the contexts at the forefront of these conversations. Having a solid theoretical basis for the role of end-of-life communication in NHs in transitioning to palliative-oriented care can offer indications for research, practice, education, and policy related to geropalliative care. This study aimed to develop a situation-specific theory of end-of-life communication in NHs by refining an existing theory. A four-step integrative approach was employed that included: (1) checking the assumptions for theorization; (2) exploring the phenomenon through multiple sources; (3) theorizing; and (4) reporting. All elements of the existing end-of-life communication theory in NHs were confirmed: end-of-life communication improved the understanding of FCs about their relatives’ health conditions, shared decision-making, and reflections on the desired preferences of residents/FCs for care at the end of life. Furthermore, the family environment affected the burden of FCs in the decision-making process. Finally, time and resource constraints, regulations, visitation restrictions due to the COVID-19 pandemic, and social and cultural values influenced the quality and timing of communication. The study findings confirmed the impact of the political, historical, social, and cultural context on end-of-life communication, thus providing the basis for a situation-specific theory.

The Financial Risks of Unpaid Caregiving During the COVID-19 Pandemic: Results From a Self-reported Survey in a Canadian Jurisdiction.
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Marani H, Allin S, McKay S, Marchildon GP.
Health Serv Insights. 2023;16:11786329221144888.
As health service delivery shifts from institutions to the home, greater care responsibilities are being imposed on unpaid caregivers. However, gaps remain concerning how these responsibilities are contributing to caregivers’ financial risk. This study describes results from an online survey conducted in late-2020 in Ontario, Canada, about the financial risks of unpaid, homebased caregiving throughout the first year of the COVID-19 pandemic. Among 190 caregivers, salient findings include difficulties paying for care expenses after the pandemic was declared than before (P = .002); more caregivers retiring or becoming unemployed during the pandemic than before (P = .013); and a significant relationship between paying out-of-pocket for a home care worker and experiencing a decrease in the availability of such support during the pandemic (P = .029). Overall, the financial stressors of caregiving during the pandemic contributed negatively to caregivers’ mental health, with 64.2% noting could be partly offset by greater government and employment-based assistance in managing care expenses and productivity losses. Findings from this study will better inform policies that aim to protect unpaid caregivers from financial risk in pandemic recovery efforts and beyond. Results may also be useful in other welfare states where unpaid caregivers provide the majority of home care services.

Background Music in elderly nursing home: a feasibility explorative study.
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Raglio A, Pelizza R, Figini C, Bencivenni A.
G Ital Med Lav Ergon. 2022 Sep;44(3):398–402.
Introduction. This study explores how a background music-listening program within residential facilities for the elderly can influence the general environment and be effective on psychological and behavioral aspects. The feasibility of this type of intervention was explored. Methods and Materials. Twenty-nine residents involved in the experiment were observed for 4 weeks in absence of a music intervention and for the same period during the experimental condition. The intervention consisted in music listening programs, designed by trained music therapists for specific objectives according to the different times of the day. Experimental and control condition effects were compared through the administration of clinical scales and observational grids. Results. The results of clinical scales showed that music listening programs reduced behavioral symptoms in 7 out of 8 people with the most severe neuropsychiatric symptoms. The observational scheme completion showed a clear improvement in all outcomes considered, with the exceptions of agitation (in the morning) and irritability (in the afternoon). Discussion. The study brings several points to attention, including the need to establish a set of criteria in music listening programs selection and administration (e.g. identification of music characteristics related to objectives and outcomes, assessment strategies, involvement of a team of professionals). Implementing evidence-based clinical practice is crucial and the highlighted results encourage the introduction of music-listening approaches as part of therapeutic interventions in elderly nursing homes.

Characteristics and value of ‘meaningful activity’ for people living with dementia in residential aged care facilities: “You’re still part of the world, not just existing”.
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Tierney L, MacAndrew M, Doherty K, Fielding E, Beattie E.
Dementia (London). 2022 Dec 6;14713012221144488.
Most residential aged care facilities support residents to participate in activities and the importance of activities that are suited to individual preferences and abilities is widely acknowledged. Participating in activities, including those considered to be ‘meaningful’ has the potential to improve residents’ quality of life. However, what makes activities meaningful for people living with dementia in residential aged care facilities is unclear. The aim of this study was to understand the key characteristics of ‘meaningful activity’ in residential aged care facilities and the perceived value of residents participating in these activities. Using a qualitative study design, this study explored ‘meaningful activities’ from the perspectives of people living with dementia in residential aged care facilities, their family members and staff. Across four residential aged care facilities, residents (n = 19) and family members (n = 17) participated in individual interviews while staff (n = 15) participated in focus group interviews. Interviews were recorded, transcribed and analysed using a qualitative content analysis approach. Participant responses suggest that the meaning of an activity is subjective, varying over time and between individuals. Key characteristics of an activity that makes it meaningful include being enjoyable, social and engaging, aligning with the persons’ interests, preferences, and abilities. To be considered meaningful, activities need to do more than occupy the person. The activity needs to be linked to a personally relevant goal and an aspect of the individuals’ identity. Participating in ‘meaningful activities’ was perceived as valuable to encourage participation and socialising, provide a sense of normality for residents and improve their wellbeing. The findings of this study further our understanding of the concept of ‘meaningful activity’ for people living with dementia in residential aged care facilities. Understanding the key attributes of ‘meaningful activity’ can also provide practical guidance for those supporting people with dementia to participate in these types of activities.

Person-Centered Climate, Garden Greenery and Well-Being among Nursing Home Residents: A Cross-Sectional Study.
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Xu L, Lou Y, Li C, Tao X, Engström M.
Int J Environ Res Public Health. 2022 Dec 31;20(1).
Nursing home residents’ well-being is often proxy-rated in studies, and few studies have explored the association between resident-rated person-centered climate, garden greenery, and resident-rated well-being. A cross-sectional study was conducted. Questionnaire data from a convenient sample of 470 nursing home residents in a city in Southeast China in 2021 were analyzed using multiple linear regressions, with block-wise models. The instruments used were the Person-centered Climate Questionnaire-Patient version, the Nursing Home Greenery Index, and, for well-being, the EuroQol-Visual Analogue Scale, the Life Satisfaction Questionnaire, and the 9-item Patient Health Questionnaire (depression symptoms). In the unadjusted models, the person-centered climate was positively associated with general health (β 0.29, p < 0.001), person-centered climate and greenery with life satisfaction (β 0.39, and 0.18; both p < 0.001), and negatively with depression (β -0.28, and β -0.23, both p < 0.001). After adjusting for personal and nursing home characteristics, the associations between person-centered climate, greenery, and well-being remained statistically significant. The three models explained 36%, 35%, and 21% of the variance in general health, life satisfaction, and depression, respectively. This study provides knowledge on person-centered climate in long-term care and the access to greenery.