Rationale for Individualizing Interventions to Promote Adjustment to the Nursing Home

This study was designed to determine whether certain variables were predictors of nursing home residents' membership in groups representing qualitative categories of nursing home adjustment. Responses of 186 residents to an open-ended question about how they handled the change to nursing home life were coded as very good, fair, or poor; an adjustment variable was created on the basis of this classification. Analysis of variance of random samples from each adjustment group showed that affect and social support varied significantly with adjustment. However, when discriminant analysis was applied, the three groups could not be differentiated using measure of affect, life satisfaction, social support, participation in the decisions leading to admission, nursing home satisfaction, or health. Based on the conclusion that adjustment to the nursing home is a unique experience for each individual, strategies were proposed for individualizing interventions to enable adjustment.     

Perceptions de la qualité de vie et de la bientraitance par des personnes âgées résidant en institution gériatrique et par leurs proches

Introduction

The present study focuses on patient-centered care and quality of life in dependent aging people living in nursing home.

Health,Healing and Wholeness in Frail Elderly People

ABSTRACT

This article explores the relationship between health, healing and wholeness in a group of twenty frail older residents of nursing homes, using in-depth interviews. While the participants in this study were all frail and lived with a number of disabilities, they demonstrated signs of transcendence in their responses to their disabilities. While independent living older adults in a previous study had all expressed fears of future vulnerability, only 45% of these nursing home residents said they had fears. Failure to thrive is discussed as one area of concern for frail older people, noting that this may stem from a lack of nourishment of the soul. Pastoral care is described as a multidisciplinary intervention for these residents, forming part of their wholistic care.     

Measuring Daytime Drowsiness in Nursing Home Residents: The MSLT-NH

A standardized method of assessing daytime drowsiness in frail nursing home residents has not been previously available. We present here the development and test characteristics of an instrument to measure daytime drowsiness in nursing home residents with cognitive and functional impairment, the Multiple Sleep Latency Test-Nursing Home (MSLT-NH). In a standardized manner, the resident is tested three times in one day (at 9 a.m., 11 a.m., and 1 p.m.) to measure the amount of time until the subject falls asleep. The average sleep latency (minutes to fall asleep) is the measure of interest. We tested the MSLT-NH in 95 residents from six community nursing homes in the Los Angeles area (82% of subjects were female; 81% were white, mean age was 86.6 years and mean score on the Mini-Mental State Examination [MMSE] was 9.4). Interrater reliability of the MSLT-NH was quite good (correlations between raters ranged from 0.98 to 0.99; all p values were <.0001). Validity was assessed by comparing MSLT-NH results to simultaneous wrist activity estimation of sleep, and by comparing MSLT-NH findings to results from nighttime sleep estimation by wrist actigraphy the night prior to MSLT-NH. The percent agreement between MSLT-NH and wrist actigraph ranged from 77% to 79% MSLT-NH results were significantly associated with peak duration of nighttime sleep episodes the night prior to testing. The MSLT-NH was also quite acceptable for use in the NH setting. In conclusion, we have developed a promising measure of daytime drowsiness in NH residents. Further testing will help establish whether this test is a clinically useful measure of daytime drowsiness from medications or other conditions in the NH setting.     

Methods for Assessing Quality of Life and Well-Being in Frail Older People

The appropriateness, reliability and convergence of differing methods and associated instruments for the assessment of quality of life and well-being in frail older people was examined in 60 ( S 65 years of age) nursing home residents. The feasibility of measuring quality of life and well-being via a variety of instruments was explored through observation (an adaptation of Dementia Care Mapping), structured interview (Schedule for the Evaluation of Individual Quality of Life - Direct Weighting), and proxy questionnaire (Pleasant Events Schedule - Alzheimer Disease; Apparent Emotion Rating Scale). The observational assessment and Pleasant Events Schedule demonstrated good reliability. Significant associations were found between well-being as assessed by observation, and active social interaction and engagement in recreation as assessed by observation, quality of life as assessed by structured interview, and enjoyment of activities as assessed by proxy questionnaire. These findings indicate the importance of social activity in later life, and the potential of different approaches for the appropriate assessment of key aspects of quality of life in frail older people.     

The Impact of Home Ownership on Life Satisfaction in Urban China: A Propensity Score Matching Analysis

China has implemented a series of socioeconomic reforms since 1978. One of the reforms allows urban residents to purchase their own houses rather than renting houses from state institutions which has resulted in a rapid increase in home ownership. This paper estimates the impact of home ownership on life satisfaction in urban China on the basis of the 2010 wave of the China General Social Survey. Special attention is paid to the methodological problem of confoundedness between the determinants of home ownership and life satisfaction. Propensity score matching (PSM) is applied to control it. The results show that PSM reduces upward estimation bias caused by confoundedness and that it is more appropriate to control confoundedness than ordered probit regression. The estimates furthermore indicate that home ownership has a significant positive impact on life satisfaction of medium- and high income urban residents. For low income urban residents, the impact is also positive, though insignificant. The outcomes connect to the objectives of national development policy and thus have several important policy implications. First, the central and local governments, especially in provinces where it is still low, may want to continue stimulating home ownership as it enhances life satisfaction. Secondly, specific programs may be designed to make home ownership financially affordable for low income groups. Thirdly, local governments may want to initiate or intensify urban (renewal) programs to improve poor public facilities including public transportation, green space and sports accommodations in the immediate vicinity of depressing low income neighborhoods.     

Changes in resident mix in nursing homes: cognitive and sensory data from a (redesigned) sampling plan

In planning and implementing a study, we unintentionally and serendipitously obtained data about changes in resident mix over a 2.8-yr. period. We screened residents of a 184-bed nursing home for cognition and sensorium in October 1984 to assess sampling feasibility for a grant proposal in preparation. At that time, 65.2% of the residents met the sampling criteria. However, in July/August 1987, after award of funding, only 5.4% of residents of the same nursing home met the cognitive and sensory criteria. We were forced to recruit from an additional six nursing homes, in which only 9.3% of residents met the sampling criteria.     

Relationships between steps taken in selecting a nursing home and consumers' satisfaction.

Analysis of data related to selection of a nursing home by 411 families of nursing home residents led to the conclusion that steps selected and taken by consumers in the selection of a home were associated with their subsequent satisfaction with the home. Satisfaction was greater (a) for families in agreement about the home selected and (b) for families who investigated all homes in an area before selecting one. Less satisfied were families (a) who were forced to make an immediate decision about placement following illness of a patient, (b) who felt they lacked sufficient time to investigate homes, and (c) who chose the first home with space available.     

养老院老人社会支持网络和生活满意度研究

本研究所用问卷的编制参照了《中国心理卫生评定量表手册》中的PASS、GWB和社会支持评定等量表。以企了解上海市区养老院老人的社会支持网络状况及其与生活满意度之间的关系。研究表明：(1)养老院老人的社会支持与其生活满意度之间存在极其显著的相关;(2)经回归分析,影响养老院老人生活满意度的最主要因素是养老院的软硬件设施条件与院中老人之间的相互支持;但在生病等特殊状况下,子女仍是最主要的支持来源;(3)对养老院中的老人来说,精神支持的需求比物质支持和认知支持更重要。     

End-of-life care in nursing homes: the interface of policy,research, and practice

Much attention has begun to focus on the quality of care for persons near the end of life. Palliative care, especially through hospice, has generated much discussion as possibly the most holistic care available. Consideration of how chronically ill older adults receive such care as a result of public policy can benefit from adopting a multidimensional perspective. This paper adopts Bronfenbrenner's ecological model to understand current end-of-life care for nursing home residents, followed by consideration of how each of these dimensions or levels of influence can be used to foster both research agendas and policy reforms to improve end-of-life care of nursing home residents. Specifically, the benefits of considering the influence of such policy initiatives as the Medicare hospice benefit and the Patient Self-Determination Act (PSDA) on end-of-life care in nursing homes and the means through which policy can be informed by clinical research is emphasized.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.     

Mental Health Services in Kentucky Nursing Homes: A Survey of Administrators

National surveys have shown that mental health problems are prevalent in long-term care and suggest that these settings are largely underserved by mental health services. Nursing home administrators are gatekeepers for mental health services in nursing homes. Administrators of Kentucky nursing homes were surveyed regarding their perceptions of mental health problems, current and future services use, satisfaction with services, and need for consultation. The response rate was 24%. Administrators appeared to underestimate mental health problems among residents. Most facilities were using at least one type of mental health service, but fewer residents received services than would be expected given the problem prevalence. Psychological services were underused, in spite of the fact that behavior management stood out as a major need. Psychiatry was more frequently used, but with less satisfaction. Results indicate significant financial and logistical barriers to mental health services. Future work is needed on developing, assessing, and disseminating models of effective service provision to long-term care.     

Functional Analytic Psychotherapy for Nursing Home Residents: A Single-Subject Investigation of Session-by-Session Changes

Nursing home settings contain unique environmental factors that may promote the acquisition and maintenance of problematic interpersonal behaviors. Functional Analytic Psychotherapy (FAP) is a contextually-based behavior therapy that can be used to modify problematic interpersonal behaviors via carefully provided and contingent in-session responses of the therapist to client behaviors. Thus, FAP would appear to be a particularly well-suited intervention approach for nursing home residents. To date, the effects of FAP have not been reported for nursing home residents. The current single case study assessed the effects of FAP on three nursing home residents using a single-subject AB design. The AB design consisted of a 2-weeks baseline phase followed by a 4-week FAP treatment phase. The nursing home residents completed pre-treatment and post-treatment measures of interpersonal relating. Client interpersonal behaviors were also recorded during each session and coded into two categories: Maladaptive in-session behaviors and adaptive in-session behaviors. Using the reliable change index and Swanson’s dsw to evaluate questionnaire outcomes, results indicated that all three participants reported a significant change in interpersonal functioning. Analysis of in-session behavior indicated that there were significant decreases in maladaptive behaviors and an increase in adaptive behaviors for two clients. Finally, observed in-session behavior changes were congruent with self-reported changes in interpersonal behavior. These results indicate that FAP was an effective intervention for these nursing home residents.     

Pro-active positioning of a social robot intervening upon behavioral disturbances of persons with dementia in a smart nursing home

Behavioral disturbances of persons with dementia residing in a nursing home impose a significant burden on other residents and on the care staff. A social robot can provide an adequate technological support tool for the caregivers by approaching a resident that exhibits a behavioral disturbance. In this paper, we focus on how to position the robot in the nursing home, taking into account the profile and location of the residents. We minimize the time between the detection of a behavioral disturbance and the robot having arrived near the resident and starting an interaction scenario. Our algorithm is evaluated using realistic data that was collected during 3 months in two Belgian nursing homes.     

Factors Influencing Level of Stress During the Nursing Home Decision Process

This investigation examined whether characteristics of elders and their caregivers and facets of the nursing home decision-making context were associated with recalled levels of stress during nursing home decision-making. Employing a conceptual framework based upon the literature on caregiver stress and nursing home decision-making, we considered a number of factors that might influence sponsors' stress as decisions were being made about nursing home placements. We examined data from telephone interviews with a sample of 142 sponsors (responsible parties) of first-time, recently admitted nursing home residents. Higher levels of reported stress were directly associated with more factors triggering the decision to admit, higher levels of competing demands, and limited time. Employment was indirectly related to higher stress through its impact on demands. Hospitalization and being the spouse or an adult child of the resident were indirectly related to stress because they were associated with limited available time. The results offer some insights into the types of individuals who may be vulnerable to higher levels of stress and the kinds of interventions that might avert high stress in the nursing home decision process.     

Domestic Stress and Well-Being of Employed Women: Interplay Between Demands and Decision Control at Home

Family researchers have suggested that shared decision control is important for coping with stressful demands at home, whereas occupational stress theorists view personal decision control as an essential coping resource. We studied the effects of home demands, personal decision control, and shared decision control at home on burnout and satisfaction with life, using Karasek’s job-demands-control model to gauge home stress and its outcomes. Participants were 133 mothers employed in secretarial and managerial jobs. We hypothesized that shared control would correlate more strongly with burnout and satisfaction with life than would personal control. In multiple regression analyses, demands had independent main effects on both outcomes. Shared control significantly predicted satisfaction with life, but not burnout, and personal control predicted neither. It is suggested that in families (as in teams), shared decision control may be a more potent coping resource than personal control.     

Social interaction patterns of geriatric home and community residents

Thirty elderly nursing home residents and ten community residing older adults were observed in group settings. Their behavior was assessed for dependent personal maintenance, independent personal maintenance, and appropriate and inappropriate behaviors. Responses by staff and peers to these behaviors were classified as positive, negative, or ignore. The frequency of occurrence of these behaviors as well as the relationship of resident to peer or staff behaviors were analyzed. Results indicate that community-residing elders' behaviors differ from nursing home residents' in quantity rather than quality of interactions. There was a lower frequency of behaviors in the nursing home residents. Though older adults respond differentially to various behaviors of other nursing home residents, staff responses were consistent regardless of residents' behavior. These results suggest that geriatric home residents' behavior can be characterized as withdrawn rather than dependent.     

How the “Not Religious” Experience and Witness Suffering and Death: Case Studies

ABSTRACT

This article is based on a subset of a multi-site (8), multi-year (4) research study that explored the cultural construction of dying and death in long-term care facilities. In open-ended interviews with residents and staff members, we learned how four individuals who describe themselves as “not religious” respond to queries about the meaning of suffering and death while working and living in long-term care.

We present case studies of two residents and two staff members from one of the sites–a secular, for-profit nursing home–who described themselves as not religious. We offer a brief history of their lives and daily activities, and present their responses to our queries about dying and death.

A finding of this article is that the nonreligious residents and staff members discussed here found significance in personal meaning systems developed through past, positive life events and present uncertainty about suffering and death. The self-described “not religious” provide another perspective on facing the end of life.     

城市居民生活满意度及其影响因素研究

为研究城市居民生活满意度的状况和影响生活满意度的因素,采用问卷方法对227名天津市居民在各项满意度上进行测量。结果显示宏观社会环境对城市居民生活满意度有重要影响．当前总体生活满意度基本乐观,多元回归分析表明,与生活满意度显著相关的因素有乐观、自尊、自由、满足、离异、欢愉和下岗等,表明基本生活保障达到一定满足后．乐观的情绪等。0理品质在生活满意度上具有重要意义。通过改善宏观社会环境和引导个人增强应对重大生活事件的能力及积极调整心态等可以保持和提高生活满意度。     

Opportunities for development via group psychotherapy in the nursing home

This paper illustrates the benefits of group therapy within the nursing home, and considers the enhancing and problematic factors in conducting groups within this setting. Growth which empowers staff and residents is possible and can be achieved despite significant challenges and social change. A lifespan developmental perspective can assist residents to achieve their maximum developmental maturity and group therapy can be effective in accomplishing that goal. This paper discusses the effect of the nursing home environment and staff on the resident, the task of the therapist in the nursing home, the value of group therapy, therapeutic goals in group therapy, what precipitates the need for group therapy in nursing homes, and the issue of group therapy with the cognitively impaired.