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'It makes life worthwhile!' Peer mentoring in long-term care—a feasibility study
Abstract
Objectives: Loneliness and depression are of increasing concern in long-term care homes made more urgent by viral outbreak isolation protocols. An innovative program called Java Mentorship was developed that engaged community volunteers and resident volunteers (mentors) as a team. The team met weekly, received education, and provided visits and guidance in pairs to socially disengaged residents (mentees). The purpose of this study was to assess the feasibility of conducting a larger study.
Method: We conducted a mixed-methods pre-post study to evaluate the program. We collected feasibility data associated with the program implementation, including assessment of the sample and ability to recruit; procedures for data collection; retention, program adherence and acceptability; and residents’ responses including loneliness, depression, purpose in life, social identity and sense of belonging outcomes. We enrolled community mentors (n = 65), resident mentors (n = 48) staff facilitators (n = 24) and mentees (n = 74) in 10 Canadian sites.
Results: Most feasibility objectives were met, and adherence and acceptability were high. Some resource challenges and low retention rates among resident mentors were noted. We found a 29% reduction in depression scores (p = .048; d = .30) and 15% reduction in loneliness scores (p = .014; d = .23). Purpose in life, social identity and sense of belonging were unchanged. Interviews among participants indicated high acceptability and positive perceptions of the program.
Conclusion: The study findings reveal a potential role for mentorship as a viable approach to reducing loneliness and depression in long-term care settings and lay the groundwork for future research.
... Other studies reported introducing therapeutic or leisure activities into nursing homes (n = 11), such as music-and art-based activities [51][52][53][54][55], intergenerational visiting programmes [56][57][58] and peer-mentoring [59][60][61]. The remaining articles described changes in the management, living arrangements and philosophy of care at nursing homes (n = 5), including a multi-componential strategy [62], a plan on how to design and execute an integrated intervention [63], the Eden Alternative programme [64] and reports on intergenerational living arrangements [65,66]. ...
... Visits included regular phone calls with university students [46] and video calls with schoolchildren [40]. Furthermore, a peermentoring programme arranged visits between community and resident mentors and cognitively impaired resident mentees [59][60][61]. Three studies described interventions establishing leisure activities, such as seasonal activities with university students [56], gardening, food preparation and related social events with schoolchildren [57]. ...
... Residents might especially be able to provide company and peer support to each if engaged in meaningful collective activities [16,79]. Working with the distinction of social and emotional loneliness can especially shed light on the mechanisms of those interventions which combine meaningful activities with the creation of new social relationships [59][60][61]. ...
Objectives
To clarify the mechanisms of interventions addressing loneliness and social isolation in older adults living in nursing homes through the involvement of primary and secondary informal caregivers.
Methods
This scoping review was performed by two independent reviewers, covering the period between 2011 and 2022 and the databases MEDLINE, CINAHL, PsycINFO and Scopus. It included terms related to (A) informal caregivers, (B) nursing homes, (C) psychosocial interventions, (D) involvement and (E) social isolation or loneliness.
Results
Thirty-three studies met the inclusion criteria. Although there were various definitions and assessment tools related to social isolation and loneliness, the studies referred to three dimensions of these concepts in nursing home residents: the quantity of social interactions, the perception of these encounters and biographical changes in social relationships. Most studies did not explicate the mechanisms of these interventions. The review uncovered the following aspects of intervention mechanisms: increasing opportunities for social contact, creating meaningful encounters, maintaining existing relationships with primary informal caregivers and establishing new ones with secondary informal caregivers.
Conclusion
Studies reporting on interventions addressing loneliness and social isolation in nursing home residents need to clarify and detail their intervention mechanisms in order to foster more targeted interventions. In addition, there is a need for further research on large-scale programs or care philosophies in this field and the development of intervention designs, which allow for tailored intervention formats in order to respond to the individual perception of social relationships.
... Overall, the characteristics of the included studies in this review indicate that the field is still very much in its infancy. This is supported by studies (n ¼ 4) reporting on the feasibility or acceptability of peer-based programmes (Eliacin et al., 2023;Fortuna et al., 2022;Fuller et al., 2022;Theurer et al., 2021). However, caution must be exercised with this interpretation as loneliness and social isolation were investigated in the context of other research agendas across physical and mental health care needs in several of the studies (Criss et al., 2022;Eliacin et al., 2023;Fortuna et al., 2022;Kotwal et al., 2021;Tinago et al., 2023). ...
... The implication here is that there could be other confounding variables impacting on how the peer support programmes were perceived. However, it also illustrates that For the studies that examined loneliness and social isolation as the primary aim of the research (Geffen et al., 2019;Joo et al., 2022;Lai et al., 2020;Abu-Rasain and Williams, 1999;Theurer et al., 2022;Theurer et al., 2021) loneliness or social isolation were found to be reduced in all but one study (Abu-Rasain and Williams, 1999). However, only one of these studies (Lai et al., 2020) was experiential, so findings should be considered within methodological limitations, in addition to no quality appraisal occurring within this review. ...
... Qualitative (n ¼ 3) methods were used (Fuller et al., 2022;Joo et al., 2022;Theurer et al., 2022). Mixed methods (n ¼ 5) were used (Eliacin et al., 2023;Abu-Rasain and Williams, 1999), of which (n ¼ 3) were evaluations (Criss et al., 2022;Theurer et al., 2021;Kotwal et al., 2021). While a variety of methods have been used to study this topic, it is apparent that the field is still very young, and the methods reflect this. ...
Purpose
Loneliness and social isolation are risk factors for morbidity and mortality and a growing health concern. Peer support is an intervention that has shown efficacy in the wider health-care arena. However, little is known about its effectiveness when working with adults and adolescents experiencing these issues. The purpose of this study is to conduct a scoping review on loneliness and social isolation in adult and youth populations.
Design/methodology/approach
A preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews was conducted. Five databases, Web of Science, Academic Search Complete, Embase, PsycINFO and Scopus were searched for peer-reviewed literature published in English from inception to 2023.
Findings
The search yielded 2,402 articles of which ( N = 12) met the inclusion criteria for this review. Peer support interventions for loneliness and social isolation are a relatively new topic of interest for academics. However, it is apparent that loneliness and social isolation cut across populations experiencing various health and social issues. More experiential research is needed to evidence the effectiveness of peer support in these areas with both adults and adolescents. Emerging areas of interest include the use of technology to deliver interventions and the use of technology to facilitate peer support implementation with populations difficult to reach.
Research limitations/implications
Peer support may be a promising social intervention to help those experiencing loneliness and social isolation associated with a range of health conditions. However, further research needs to be undertaken in this emerging area of practice.
Originality/value
Loneliness and social isolation are of increasing concern. To the best of the authors’ knowledge, this is the first scoping review conducted in this area
... A second approach that focuses more on the social empowerment of people living with dementia is peer mentoring. Theurer et al. [71,72] trained people living with dementia in residential long-term care and volunteers as mentors to improve the social engagement of vulnerable groups, such as new residents or residents who refuse to participate in the social activities offered. In this program, people living with dementia are empowered to take on the role of a mentor by visiting the mentees in pairs. ...
... Skrajner et al. [73] have demonstrated that it is also possible to empower people living with dementia to lead group activities for their peers in long-term care facilities. The results of this pioneering work on peer mentoring approaches are promising in terms of their impact on psychosocial health and their feasibility, but further research is needed on both outcomes [71][72][73]. ...
Background
The importance of social health is increasingly recognized in dementia research. For most people living with dementia, their social environment changes as the disease progresses, especially when they move into a long-term care facility. However, maintaining social interactions in the new living environment contributes significantly to health and quality of life. Staff and other residents are the most readily available interaction partners to provide this. The aim of this study is to investigate the frequency, contexts, partners and influencing factors (personal and contextual) of social interactions of people living with dementia in residential long-term care.
Methods
Participants were observed for two days in 20-min slots (from 7 am to 7 pm) in 12 long-term care facilities in Germany. The Maastricht Electronic Daily Live Observation Tool (MEDLO-tool) was used for ecological momentary assessment. Age, gender, functional status, cognitive status and length of stay at the facility were recorded. Generalized linear mixed-effect models were used for the data analysis.
Results
In all, 106 people living with dementia (average age: 85.16 ± 7.42 years, 82.9% female) were observed at 6134 time points. No social interaction take place in 71.9% of the observations. The place where the participants spend their time influences the occurrence of social interaction (p < 0.001), with a significantly higher probability of social interaction in communal spaces. Most frequently, interaction takes place with staff (43.4%), closely followed by other residents (40.9%), with the context (location, p < 0.001; time of day, p < 0.001) and functional status (care level, p < 0.001) influencing which of the two groups people living with dementia interact with.
Conclusion
A better understanding of the context of social interactions and its influencing factors provide a basis for more targeted interventions. As the increasing staff shortage will further limit the opportunities for social interaction with staff, future concepts should focus on other residents. Meaningful activities that enable people living with dementia to co-operate and share responsibility can provide a stimulating framework for this. In addition, social assistance robots and the application of peer-mentoring/leading represent promising approaches for creating a socially interactive environment.
... However, some older adults who live in a CCRC may experience social isolation (i.e., a lack of interaction with others), and/or loneliness (i.e., subjective feelings of a lack of companionship; Leigh-Hunt et al., 2017;Savikko et al., 2005), despite being in the company of others (Jansson et al., 2017). Moving into a CCRC brings a sudden change in living arrangement that can be disconcerting given the unfamiliar setting and reduced in-person interactions with life-long family, friends, and acquaintances (Theurer et al., 2021). Notably, social isolation and loneliness are both associated with poor health and well-being (Freedman & Nicolle, 2020;Santini et al., 2020) -compromising sleep quality, mood, cognition, and even contributing to mortality (Friedler et al., 2015;Gow et al., 2007;Yoon, 2016). ...
... Older adults also tend to be more emotionally invested in rewarding social interactions with their established networks and cautious about exploring new opportunities for social interaction Yang & Moffatt, 2024). In relation to CCRCs, the presupposition is that these communities offer new opportunities to increase life satisfaction by engaging and connecting with others (Lim et al., 2007;Sepúlveda-Loyola et al., 2020;Theurer et al., 2021). However, living in a CCRC can also challenge one's psychosocial wellbeing (Pudur et al., 2023). ...
... Mentees gained confidence in relation to their competence, which maximised the impact of the skills and knowledge they already possessed, as well as placed them in a better position to ask for help or respond to mistakes. Other international models use 'mentors' focussed on residents (Theurer et al., 2021) or students (Kung et al., 2023). The recruitment of 'Emeritus' nurses may hold important elements of experienced mentors for future developments (Boerger et al., 2019). ...
Aims
To explore the experience of registered nurses and their mentors in the implementation of the Gerontological Nursing Competencies in long‐term aged care and the perceived effectiveness and suitability of the programme to support nurse development.
Background
The global population is ageing and needs a reliable aged‐care nursing workforce.
Introduction
Opportunities for education and mentorship for newly qualified and experienced aged‐care nurses warrant investigation.
Methods
Qualitative evaluation using semi‐structured focus groups was conducted following the implementation of the programme into five not‐for‐profit long‐term aged‐care organisations and analysed by a reflexive qualitative thematic approach and reported according to COREQ criteria.
Results
A total of 21 nurses (7 mentors and 14 mentees) participated in six focus groups. Five themes were generated: (1) nurses gained confidence and competence through the programme; (2) the facilitation of suitable mentoring activities and approaches was crucial to success; (3) the programme helps nurses recognise gerontology as a specialty; (4) the programme contributes to building a strategy of recruitment/retention/quality improvement in the sector; (5) barriers, challenges, changes and recommendations were identified.
Discussion
The Gerontological Nursing Competency model, which combined adaptive mentoring supported by reflective practice embedded in a gerontological nursing competencies framework, was perceived to improve nurse confidence and competence to lead and improve nursing standards of care.
Conclusion and implications for nursing and health policy
The evidence‐based competencies are an acceptable and effective method for supporting gerontological nurse development. Expansion of, and accessibility to, the programme may aid global responses to aged‐care reform, by building the recognition of gerontological nursing as a specialty and contributing towards recruitment, retention and quality care improvements.
... Peer mentoring, particularly using a group or team approach, may have the potential to augment limited mental health services in these settings Stone & Bryant, 2012) and honour the rights of people living in long-term care. A feasibility study examining a team approach to mentoring has demonstrated reductions in loneliness and depression among the mentors Theurer et al., 2020a) and among those being visited Theurer et al., 2020b). ...
Social isolation and loneliness in long-term care settings are a growing concern. Drawing on concepts of social citizenship, we developed a peer mentoring program in which resident mentors and volunteers formed a team, met weekly for training, and paired up to visit isolated residents. In this article, we explore the experiences of the resident mentors. As part of a larger mixed-methods study conducted in 10 sites in Canada, we interviewed mentors ( n = 48) and analysed data using inductive thematic analysis. We identified three inter-related themes: Helping others, helping ourselves described the personal benefits experienced through adopting a helping role; Building a bigger social world encapsulated new connections with those visited, and; Facing challenges, learning together described how mentors dealt with challenges as a team. Our findings suggest that a structured approach to mentoring benefits residents and helps them feel confident taking on a role supporting their isolated peers.
Despite the growing popularity of walking sports, little is known about who is attracted to them, and what skills, motivations, and experiences encourage ongoing participation. The aim of this study was to gain an in-depth understanding of the phenomenon of walking football in Australia. The authors first conducted semistructured interviews with 53 older adults ( M = 62.37 years, 30.19% female) participating in walking football in Australia. Next, they conducted thematic analysis to develop themes that represented participant perspectives. Results indicated that walking football led to several physical benefits, but the social and mental benefits seemed to be more closely associated with continued participation. The slower pace of walking football created a valuable option to engage in physical activity among those with injuries or severe health issues, as well as older adults concerned about injuries. The slower pace also shifted the focus of walking football away from fitness and ability, and toward technique and skill development, and this focus, along with the mix in abilities, led to informal coaching and mentoring roles which were highly valued among older participants. Participant views about competition in walking football were diverse, with some expressing a mild concern. Understanding such diverse experiences of walking football helps to better understand how different aspects of the sport influence the perceived benefits and likelihood of continuing for different people. Using these findings to further develop walking sports in Australia could have large impacts on the health and well-being of older people.
In contemporary western cultures, such as Australia, there is increasing reported social disconnection. This disconnection is associated with loneliness and for some suicide, particularly for men. Voluntary male mentoring organisations aim to socially connect and improve men's wellbeing through facilitating men's one‐to‐one relationships. As is the case with most people, men value someone with whom they may communicate openly and safely, as occurs in voluntary mentoring. However, there is limited research on voluntary male mentoring or the experiences of the participants. This scoping review of the literature from voluntary adult male mentoring thematically synthesises the reported narratives from mentors. A systematic search was undertaken of five academic databases on voluntary adult male mentoring for scholarly articles in English. Additionally, the returned articles had their references reviewed for relevant authoritative reports and publications. After duplicates were removed, there were 471 publications. Sources included publications from humanities, social science, psychology and the health sciences. Once screened for eligibility this number was reduced to 29 publications. A thematic synthesis of the literature found the concepts of intentional relationship, journey and mutual growth were present. The implications of these findings are that men in community settings, informed by the experience of voluntary mentors, may be prepared to engage with other men. Additional research on the lived experience of mentors may offer further insights into facilitating male connection.
Objectives
To explore older care home residents’ experiences of maintaining a sense of purpose in life: a core component of psychological wellbeing.
Methods
Fifteen residents (9 female; 6 male), aged 60-95 years, from four care homes, were interviewed about their sense of purpose. Interview transcripts were analysed using inductive thematic analysis.
Results
Theme 1 (‘Experiencing Loss’) comprises two sub-themes that describe the impact of age-related losses on residents’ sense of purpose (sub-theme 1) and the different responses that participants had to these losses (sub-theme 2). Theme 2 (‘The Protective Effects of Social Connections’) describes how social relationships could provide a sense of purpose, as well as the difficulties participants experienced in forming these relationships. Finally, theme 3 (‘The Roles of Activities’) describes the types of activities that could help residents to maintain a sense of purpose.
Conclusion
Care home residents experience losses and barriers that make it more difficult to maintain a sense of purpose. However, with appropriate support and opportunities, residents are able to engage in activities and relationships that provide a sense of purpose. To support residents’ mental health and wellbeing, care homes should offer varied opportunities for residents to engage in purposeful activities.
Loneliness, depression, and social isolation are common among people living in long-term care homes, despite the activities provided. We examined the impact of a new peer mentoring program called Java Mentorship on mentees’ loneliness, depression, and social engagement, and described their perceptions of the visits. We conducted a mixed-methods approach in 10 homes in Ontario, Canada, and enrolled residents as mentees ( n = 74). We used quantitative surveys and qualitative interviews to understand their experience. After 6 months, mentees ( n = 43) showed a 30% reduction in depression ( p = .02, d = .76), a 12% reduction in loneliness ( p = .02, d = .76), and a 60% increase in the number of monthly programs attended ( p = .01, d = .37), with small-to-medium effect sizes. The analysis of mentee’s interviews revealed positive perceptions. This program offers an innovative, nonpharmacological alternative to the treatment of loneliness and depression.
Background:
The main objective is to better understand the prevalence of depressive symptoms, in long-term care (LTC) residents with or without cognitive impairment across Western Canada. Secondary objectives are to examine comorbidities and other factors associated with of depressive symptoms, and treatments used in LTC.
Methods:
11,445 residents across a random sample of 91 LTC facilities, from 09/2014 to 05/2015, were stratified by owner-operator model (private for-profit, public or voluntary not-for-profit), size (small: < 80 beds, medium: 80-120 beds, large > 120 beds), location (Calgary and Edmonton Health Zones, Alberta; Fraser and Interior Health Regions, British Columbia; Winnipeg Health Region, Manitoba). Random intercept generalized linear mixed models with depressive symptoms as the dependent variable, cognitive impairment as primary independent variable, and resident, care unit and facility characteristics as covariates were used. Resident variables came from the Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0 records (the RAI-MDS version routinely collected in Western Canadian LTC). Care unit and facility variables came from surveys completed with care unit or facility managers.
Results:
Depressive symptoms affects 27.1% of all LTC residents and 23.3% of LTC resident have both, depressive symptoms and cognitive impairment. Hypertension, urinary and fecal incontinence were the most common comorbidities. Cognitive impairment increases the risk for depressive symptoms (adjusted odds ratio 1.65 [95% confidence interval 1.43; 1.90]). Pain, anxiety and pulmonary disorders were also significantly associated with depressive symptoms. Pharmacologic therapies were commonly used in those with depressive symptoms, however there was minimal use of non-pharmacologic management.
Conclusions:
Depressive symptoms are common in LTC residents -particularly in those with cognitive impairment. Depressive symptoms are an important target for clinical intervention and further research to reduce the burden of these illnesses.
Objective: The aim of this paper was to review prevalence rates of loneliness, anxiety, and depression among older people living in long-term care settings such as residential aged care facilities, nursing homes and assisted living facilities. Method: A systematic search of the literature was conducted using several electronic databases including Medline, CINAHL, PsycINFO, and the Cochrane library. Results: In total, 18 articles met the inclusion criteria for this review. The results indicated that the prevalence rates of loneliness (56% to 95.5%), anxiety (3.6% to 38%), and depression (11% to 85.5%) in older people living in long-term care settings are generally high. Conclusion: Further research on effective methods of reducing these symptoms is recommended.
Objectives:
To explore the perceptions of patients, physiotherapists, and potential peer mentors on the topic of peer-mentoring for self-management of chronic low back pain following discharge from physiotherapy.
Design:
Exploratory, qualitative study.
Participants:
Twelve patients, 11 potential peer mentors and 13 physiotherapists recruited from physiotherapy departments and community locations in one health board area of the UK.
Interventions:
Semi-structured interviews and focus groups.
Main outcome measures:
Participants' perceptions of the usefulness and appropriateness of peer-mentoring following discharge from physiotherapy. Data were processed and analysed using the framework method.
Results:
Four key themes were identified: (i) self-management strategies, (ii) barriers to self-management and peer-mentoring, (iii) vision of peer-mentoring, and (iv) the voice of experience. Peer-mentoring may be beneficial for some older adults with chronic low back pain. Barriers to peer-mentoring were identified, and many solutions for overcoming them. No single format was identified as superior; participants emphasised the need for any intervention to be flexible and individualised. Important aspects to consider in developing a peer-mentoring intervention are recruitment and training of peer mentors and monitoring the mentor-mentee relationship.
Conclusions:
This study has generated important knowledge that is being used to design and test a peer-mentoring intervention on a group of older people with chronic low back pain and volunteer peer mentors. If successful, peer-mentoring could provide a cost effective method of facilitating longer-term self-management of a significant health condition in older people.
Loneliness and depression are serious mental health concerns across the spectrum of residential care, from nursing homes to assisted and retirement living. Psychosocial care provided to residents to address these concernsik is typically based on a long-standing tradition of 'light' social events, such as games, trips, and social gatherings, planned and implemented by staff. Although these activities provide enjoyment for some, loneliness and depression persist and the lack of resident input perpetuates the stereotype of residents as passive recipients of care. Residents continue to report lack of meaning in their lives, limited opportunities for contribution and frustration with paternalistic communication with staff. Those living with dementia face additional discrimination resulting in a range of unmet needs including lack of autonomy and belonging-both of which are linked with interpersonal violence. Research suggests, however, that programs fostering engagement and peer support provide opportunities for residents to be socially productive and to develop a valued social identity. The purpose of this paper is to offer a re-conceptualization of current practices. We argue that residents represent a largely untapped resource in our attempts to advance the quality of psychosocial care. We propose overturning practices that focus on entertainment and distraction by introducing a new approach that centers on resident contributions and peer support. We offer a model-Resident Engagement and Peer Support (REAP)-for designing interventions that advance residents' social identity, enhance reciprocal relationships and increase social productivity. This model has the potential to revolutionize current psychosocial practice by moving from resident care to resident engagement.
A study of residents of a nursing facility showed that social relationships formed with other residents was a much stronger predictor of depression and loneliness than social relationships with friends and relatives from outside the institution.
In this article, we highlight the distinctive features of a feasibility study, identify the main objectives and guiding questions of a feasibility study, and illustrate the use of these objectives. We synthesized the research methods literature related to feasibility studies to identify five overarching objectives of feasibility studies that focus on social and behavioral interventions. Feasibility studies are designed to answer the overarching question: Can it work? The main objectives of feasibility include the assessment of recruitment capability and resulting sample characteristics, data collection procedures and outcome measures, acceptability of the intervention and study procedures, resources and ability to manage and implement the study and intervention, and preliminary evaluation of participant responses to the intervention. For each objective, we identified follow-up questions designed to assist the researchers to understand barriers to the ultimate success of the research.
Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face-to-face panel meeting. The resultant 12-item TIDieR checklist (brief name, why, what (materials), what (procedure), who intervened, how, where, when and how much, tailoring, modifications, how well (planned), how well (actually carried out)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with a detailed explanation of each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure the accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
© Georg Thieme Verlag KG Stuttgart · New York.
Social relationships play a key role in depression. This is apparent in its etiology, symptomatology, and effective treatment. However, there has been little consensus about the best way to conceptualize the link between depression and social relationships. Furthermore, the extensive social-psychological literature on the nature of social relationships, and in particular, research on social identity, has not been integrated with depression research. This review presents evidence that social connectedness is key to understanding the development and resolution of clinical depression. The social identity approach is then used as a basis for conceptualizing the role of social relationships in depression, operationalized in terms of six central hypotheses. Research relevant to these hypotheses is then reviewed. Finally, we present an agenda for future research to advance theoretical and empirical understanding of the link between social identity and depression, and to translate the insights of this approach into clinical practice.
Personhood has provided a lens for conceptualising dementia practice and research for over ten years. It has afforded the rationale and language for improving care and for raising consciousness about the status of people with dementia, as people, intrinsically worthy of respect. However, because personhood is essentially an apolitical concept concerned with psychosocial issues it may be too limiting. Citizenship provides another possible lens. Citizenship is used in cognate disciplines to promote the status of discriminated groups of people still further, to that of a person with power entitled to the same from life as everyone else. However, as citizenship tends to assume the self-cognizance to exercise rights and responsibilities, it may not be as appropriate for people with severe dementia. Both concepts are problematic then, taking too narrow a view of the human experience. For this field to develop over the next ten years it clearly needs a wider lens that is both inclusive of personhood and citizenship, but which also recognizes the complexities of human experience. This article reviews the relevance of personhood and citizenship for dementia practice and research, and argues for a broader lens that incorporates citizenship and sociological ideas about agency and structure.
For the past few decades, researchers have been evaluating the effects of self-help/mutual aid groups on participants. Most research studies of self-help groups have found important benefits of participation. Unfortunately, few of these studies have gotten into the hands of self-help group members, clearinghouse staff and others who wish to advocate for self-help/mutual aid. The purpose of this chapter is to help correct this problem by summarizing the best research supporting the effectiveness of self-help groups in a brief and clear fashion.
Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.
The high prevalence of mental disorders among residents of long-term care (LTC) homes is highlighted in the paper by Seitz et al. in this special issue of International Psychogeriatrics. The International Psychogeriatric Association's Task Force on Mental Health Services in LTC Homes was formed in 2005 with two goals: (1) to gather information and share views from diverse countries and settings about how best to restore or ensure good mental health in LTC settings; and (2) to support and strengthen mental health services in the LTC sector. Since its formation, groups of members of the Task Force have visited residential facilities in Stockholm, Lisbon, Istanbul, Osaka, Dublin, Montreal and the Netherlands. Members have also reported on visits to LTC homes in the U.S.A., U.K., Korea, Thailand, South Africa and Nigeria. Further visits have been arranged during the IPA's meeting in Spain in September 2010. Information has also been provided by members in discussion groups and in response to a Task Force survey about facilities in various other countries.
The author reflects on the impact of dementia amongst older people. The author mentions that dementia is a major health related problem in the developed countries. The author mentions that according to a statistics around 700,000 people in Great Britain are suffering from dementia and it is expected to cover around 1.7 million people by the year 2050. The author further discusses the reluctance of the society to help people suffering from dementia.
We test associations of frequency of performing three types of socially productive activities (voluntary work, informal help and caring for a person) with depressive symptoms in older people. Are depressive symptoms negatively associated with frequency in all three types or rather in those activities that are characterized by a high degree of autonomy and perceived control?
Data on social activities and frequency of performance were collected in the frame of the annual follow-up of the French GAZEL cohort study in 2005. Depressive symptoms were measured by the CES-D scale. Perceived control was assessed by two items of a quality of life measure (CASP-19). Total of 14477 respondents aged 52-66 years completed a standardized questionnaire. Linear regression models were calculated adjusting for important confounders including self-rated health assessed during the previous year.
In activities characterized by high autonomy (in particular voluntary work) a negative association of frequency with depressive symptoms was observed, whereas the reverse effect was found in the type of activity with low autonomy (care for a person). Perceived control mediated in part the association of frequency of activity with depressive symptoms.
Being often socially productive in early old age may contribute to well-being to the extent that autonomy and perceived control are given.
The purpose of this mixed-methods study was to measure perceived social standing within an assisted living (PSS-AL), and to identify individual determinants and empirical correlates of this construct. The sample consisted of 200 residents of 21 assisted livings (ALs). A self-anchoring ladder measured PSS-AL ( M = 6.95, SD = 2.04) and an open-ended follow-up question assessed individual determinants of PSS-AL ratings. In a multiple regression, mental health ( β = .27, p = .001), intimate staff-resident relationships ( β = .22, p = .024), and extraversion ( β = .27, p < .001) were significant predictors of PSS-AL. Qualitative findings revealed that inter-personal factors, prosocial behaviors, and health were key determinants of PSS-AL. Results highlight the social demands of AL and associated implications for residents with varying social abilities, skills, and interests. Findings also suggest that staff-resident relationships may shape and-or reinforce resident social hierarchies. The authors discuss implications for research and practice.
Aims and objectives:
To explore nursing home residents' perspectives on their relationships with other residents, family members, and staff.
Background:
The cultivation of social relationships is central to promoting well-being in nursing homes, as these relationships allow residents, family members, and staff to be valued as unique persons and empowered as partners in care. Few studies have examined how nursing home residents perceive the relationships in their social networks, both within and beyond the facility.
Design:
Qualitative secondary analysis.
Methods:
We analyzed individual and group interviews obtained during "stakeholder engagement sessions" with cognitively intact residents (N = 11 sessions; N = 13 participants) from two nursing homes in North Carolina. The interviews were conducted as part of a larger study on person-directed care planning. We integrated thematic and narrative analytic approaches to guide the analysis of interview data, using a three-cycle coding approach. The COREQ checklist was followed.
Results:
Four broad themes emerged from this analysis: (1) peer relationships foster a sense of belonging, purpose, achievement, and significance, (2) residents' relationships with family members support a sense of belonging, continuity, and significance, (3) mutual respect and reciprocity between residents and nursing home staff promote a sense of belonging and significance (4) organizational factors pose barriers to forging meaningful relationships. Each type of relationship-peer, family, and staff-made distinctive contributions residents' psychosocial well-being.
Conclusion:
Recognizing the diverse roles of different actors from residents' social networks raises questions for future research to optimize the distinctive contributions of network members that promote residents' psychosocial well-being.
Relevance to clinical practice:
This study highlights the need for nursing home staff to understand how residents' social relationships influence residents' psychosocial outcomes. Staff training programs are needed to support residents' rights and to dispel inaccurate interpretations of regulations that threaten sustained meaningful relationships.
Dementia has been widely debated from the perspectives of biomedicine and social psychology. This book broadens the debate to consider the experiences of men and women with dementia from a sociopolitical perspective. It brings to the fore the concept of social citizenship, exploring what it means within the context of dementia and using it to re-examine the issue of rights, status(es), and participation. Most importantly, the book offers fresh and practical insights into how a citizenship framework can be applied in practice. It will be of interest to health and social care professionals, policy makers, academics and researchers and people with dementia and family carers may find it revitalising.
Mentorship has been around for years and has been explored in nursing education in the clinical settings. Despite evidence that indicates that the academic environment is the most common source of stress, little mentorship implementation and investigation has been done in this environment. The purpose of this research is to describe the effects of a mentorship experience on the level of perceived stress, sense of belonging, self-efficacy, and loneliness by first year baccalaureate nursing students. A quasi-experimental design was conducted. Seventy baccalaureate nursing students in the first year of their program (n = 34 in the experimental group; n = 36 in the control group) enrolled in a single baccalaureate nursing program were recruited. Third year mentors were purposefully selected by nursing professors within the program. The Perceived Stress Scale, the College Self-Efficacy Inventory (CSEI)–Revised, Sense of Belonging-Psychological, Sense of Belonging-Antecedents, and the Revised UCLA Loneliness Scale were used to evaluate the various concepts as these tools were used in previous research with college level students and deemed to be reliable and valid tools for measuring the relevant concepts. The mentorship program was statistically significant in reducing first year nursing students’ perceived stress and loneliness. It also appeared to increase their sense of self-efficacy and psychological sense of belonging. The mentorship experience could potentially enhance the student experience as well as aid the academic institution in retention and resource maximization. The focus of this research was on the academic mentoring by peers and is worth further exploration and possible wide-scale integration within nursing education.
Purpose: The aim of this study was at gaining insight into the participatory design approach of involving people with dementia in the development of the DecideGuide, an interactive web tool facilitating shared decision-making in their care networks.
Method: An explanatory case study design was used when developing the DecideGuide. A secondary analysis focused on the data gathered from the participating people with dementia during the development stages: semi-structured interviews (n = 23), four focus group interviews (n = 18), usability tests (n = 3), and a field study (n = 4). Content analysis was applied to the data.
Results: Four themes showed to be important regarding the participation experiences of involving people with dementia in research: valuable feedback on content and design of the DecideGuide, motivation to participate, perspectives of people with dementia and others about distress related to involvement, and time investment.
Conclusions: People with dementia can give essential feedback and, therefore, their contribution is useful and valuable. Meaningful participation of people with dementia takes time that should be taken into account. It is important for people with dementia to be able to reciprocate the efforts others make and to feel of significance to others.
• Implications for Rehabilitation
• People with dementia can contribute meaningfully to the content and design and their perspective is essential for developing useful and user-friendly tools.
• Participating in research activities may contribute to social inclusion, empowerment, and quality of life of people with dementia.
Background and purpose:
Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions.
Method:
In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]).
Results:
The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was.56 (95% confidence interval=.47-.65) for ratings by individuals, and the ICC for consensus ratings was.68 (95% confidence interval=.57-.76).
Discussion and conclusion:
The reliability of ratings of PEDro scale items varied from "fair" to "substantial," and the reliability of the total PEDro score was "fair" to "good."
Objectives:
Traditional mental health services are not used by a majority of older adults with depression, suggesting a need for new methods of health service delivery. We conducted a pilot study using peer mentors to deliver depression care to older adults in collaboration with a mental health professional. We evaluated the acceptability of peer mentors to older adults and examined patient experiences of the intervention.
Methods:
Six peer mentors met 30 patients for 1 hour weekly for 8 weeks. A mental health professional provided an initial clinical evaluation as well as supervision and guidance to peer mentors concurrent with patient meetings. We measured depressive symptoms at baseline and after study completion, and depressive symptoms and working alliance at weekly peer-patient meetings. We also interviewed participants and peer mentors to assess their experiences of the intervention.
Results:
Ninety-six percent of patients attended all eight meetings with the peer mentor and PHQ-9 scores decreased for 85% of patients. Patients formed strong, trusting relationships with peer mentors. Patients emphasized the importance of trust, of developing a strong relationship, and of the credibility and communication skills of the peer mentor. Participants described benefits such as feeling hopeful, and reported changes in attitude, behavior, and insight.
Conclusions:
Use of peer mentors working in collaboration with a mental health professional is promising as a model of depression care delivery for older adults. Testing of effectiveness is needed and processes of recruitment, role definition, and supervision should be further developed.
The latest phase of the ARF's 'Foundations of Quality' research initiative was designed to address newly raised questions about the quality of online samples developed. This article explores the impact of respondents who do not provide accurate responses to questions, especially in reference to topics of a sensitive nature such as politics and actions that affect one's health.
The aim of this investigation was to present new empirical evidence regarding the psychometric properties of the short-form UCLA Loneliness Scale (ULS-6) among Portuguese older people. The study included 1,154 persons (60 % women and 40 % men), aged 60–90 (M = 71.26; SD = 6.66). The psychometric properties of the ULS-6 were analysed by means of confirmatory factor analysis, internal consistency, and criterion-related validity methods. Confirmatory factor analysis supported a unidimensional structure of the measure with adequate values of various fit indices. The ULS-6 presented satisfactory psychometric properties, with a high level of internal consistency. Furthermore, the ULS-6 showed a negative relationship with self-esteem, satisfaction with life, and positive affect; and a positive one with negative affect. The results confirm that the ULS-6 provides a brief, psychometrically sound measure of loneliness that is appropriate for use among older adults.
Approximately 5% of older people, those aged 65 years and over, in developed countries live in care homes and these represent the frailest and most vulnerable members of this population group. Levels of morbidity, especially dementia and cognitive impairment, are high, making it challenging to conduct research with these population groups. Loneliness is a debilitating condition with important negative outcomes in terms of both quality of life and wider health outcomes. The prevalence of severe loneliness among older people living in care homes is at least double that of community-dwelling populations: 22-42% for the care population compared with 10% for the community population. However, the evidence-base for the care home group is tentative as it is based upon a very limited empirical base of only five studies. This review failed to identify compelling evidence for the effectiveness of interventions to remediate loneliness in care home populations.
Assisted living residences have become prominent sites of long-term residential care for older adults with dementia. Estimates derived from national data indicate that seven out of ten residents in these residences have some form of cognitive impairment, with 29 percent having mild impairment, 23 percent moderate impairment, and 19 percent severe impairment. More than one-third of residents display behavioral symptoms, and of these, 57 percent have a medication prescribed for their symptoms. Only a minority of cognitively impaired residents reside in a dementia special care unit, where admission and discharge policies are more supportive of their needs. Policy-relevant recommendations from our study include the need to examine the use of psychotropic medications and cultures related to prescribing, better train assisted living staff to handle medications and provide nonpharmacological treatments, use best practices in caring for people with dementia, and promote consumer education regarding policies and practices in assisted living.
Social identity research was pioneered as a distinctive theoretical approach to the analysis of intergroup relations but over the last two decades it has increasingly been used to shed light on applied issues. One early application of insights from social identity and self-categorization theories was to the organizational domain (with a particular focus on leadership), but more recently there has been a surge of interest in applications to the realm of health and clinical topics. This article charts the development of this Applied Social Identity Approach, and abstracts five core lessons from the research that has taken this forward. (1) Groups and social identities matter because they have a critical role to play in organizational and health outcomes. (2) Self-categorizations matter because it is people's self-understandings in a given context that shape their psychology and behaviour. (3) The power of groups is unlocked by working with social identities not across or against them. (4) Social identities need to be made to matter in deed not just in word. (5) Psychological intervention is always political because it always involves some form of social identity management. Programmes that seek to incorporate these principles are reviewed and important challenges and opportunities for the future are identified.
The dominant clinical view of dementia and its treatment are through the biomedical lens-an approach to understanding the dementias that focuses on bodily and mental pathology and symptomology. Person-centered care (PCC) represents a shift in focus away from biomedical approach in elder care. The primary objective of this research was to examine how PCC was defined, shaped, and practiced by staff members within a dementia care setting.
Ethnographic data were collected over an 8-month period using participant observation (400hr) and ethnographic interviews with 20 people with dementia and 25 staff members of Cedar Winds, a dementia-specific long-term care setting that had a strong organizational support for using a person-centered approach to dementia care.
The observed cultural matrix of othering is the focus of this article and represents the cultural processes that prevented PCC from being enacted within Cedar Winds. The three main characteristics through which the residents were othered and PCC was obstructed were (a) dementia as a master status, (b) functional dependence, and (c) aggressiveness.
This article concludes by examining the efforts that could reduce the extent of othering and improve the person centeredness of elder care settings.
In order to understand variations of quality of life in early old age, associations between socio-economic status, socially productive activities and well-being are studied across 14 European countries. Information on three different types of productive activities and their exchange characteristics is included. We used the first two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) including some 15,000 retired men and women. Well-being is measured by a standardized quality of life measure (CASP-12). Findings of multilevel analyses show larger within-country than between-country variability in prospective quality of life. Strong individual predictors were the experience of reciprocity in social productive activities and high socio-economic position. Continued participation in socially productive activities, in particular those that offer opportunities of experiencing reciprocity in exchange, improves prospective quality of life in early old age.
Objective:
To examine the relationship of social isolation, loneliness and health outcomes among older adults.
Methods:
Using data from the Leave Behind Questionnaire of the Health and Retirement Study (2006 and 2008), (n = 11,825) several indicators of social isolation were scaled and the Hughes 3-Item Loneliness Scale was used. Two measures of health (self-rated health and mental health conditions) were examined using logistic regression.
Results:
Loneliness and social isolation were not highly correlated with one another (r = 0.201, p = 0.000). Loneliness was associated with higher odds of having a mental health problem (OR: 1.17; CI: [1.13, 1.21], p = 0.000); and isolation was associated with higher odds of reporting one's health as being fair/poor (OR:1.39; CI: [1.21, 1.59], p = 0.000).
Discussion:
The results suggest that global measures of isolation, that fail to distinguish between social isolation and feelings of loneliness, may not detect the impact on physical and mental health in older adults.
This research investigated facets of the volunteer ombudsman's role as related to orientation, performance, and satisfaction. The status of the volunteer, whether active or inactive, and their perceptions of barriers to ongoing participation was examined. The majority of the volunteers identified their primary orientation as that of therapeutic supporter, a friendly visitor who provided emotional support to residents. This type of volunteer was more likely to remain in the program longer than the other orientations of advocate or mediator. Former volunteers reported more resistance from nursing home staff, had significantly less success in resolving issues, felt their needs as volunteers were overlooked, and received less continuing training. These former volunteers were far less likely to recommend volunteering in the ombudsman program to their friends or family. Since volunteer programs depend upon a positive or at least neutral experience from participants, recruiting and retaining participants remains problematic.
This paper introduces a single-item social identification measure (SISI) that involves rating one's agreement with the statement 'I identify with my group (or category)' followed by a 7-point scale. Three studies provide evidence of the validity (convergent, divergent, and test-retest) of SISI with a broad range of social groups. Overall, the estimated reliability of SISI is good. To address the broader issue of single-item measure reliability, a meta-analysis of 16 widely used single-item measures is reported. The reliability of single-item scales ranges from low to reasonably high. Compared with this field, reliability of the SISI is high. In general, short measures struggle to achieve acceptable reliability because the constructs they assess are broad and heterogeneous. In the case of social identification, however, the construct appears to be sufficiently homogeneous to be adequately operationalized with a single item.
What if being lonely were a bigger problem than we ever suspected? Based on John T. Cacioppo's pioneering research,
Loneliness explores the effects of this all-too-human experience, providing a fundamentally new view of the importance of social connection and how it can rescue us from painful isolation. His sophisticated studies relying on brain imaging, analysis of blood pressure, immune response, stress hormones, behavior, and even gene expression show that human beings are simply far more intertwined and interdependent—physiologically as well as psychologically—than our cultural assumptions have ever allowed us to acknowledge. Bringing urgency to the message, Cacioppo's findings also show that prolonged loneliness can be as harmful to your health as smoking or obesity. On the flip side, they demonstrate the therapeutic power of social connection and point the way toward making that healing balm available to everyone. Cacioppo has worked with science writer William Patrick to trace the evolution of these tandem forces, showing how, for our primitive ancestors, survival depended not on greater brawn but on greater commitments to and from one another. Serving as a prompt to repair frayed social bonds, the pain of loneliness engendered a fear response so powerfully disruptive that even now, millions of years later, a persistent sense of rejection or isolation can impair DNA transcription in our immune cells. This disruption also impairs thinking, will power, and perseverance, as well as our ability to read social signals and exercise social skills. It also limits our ability to internally regulate our emotions—all of which can combine to trap us in self-defeating behaviors that reinforce the very isolation and rejection that we dread.
Loneliness shows each of us how to overcome this feedback loop of defensive behaviors to achieve better health and greater happiness. For society, the potential payoff is the greater prosperity and social cohesion that follows from increased social trust. Ultimately,
Loneliness demonstrates the irrationality of our culture's intense focus on competition and individualism at the expense of family and community. It makes the case that the unit of one is actually an inadequate measure, even when it comes to the health and well-being of the individual. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
RESUME
Cette revue de la documentation sur les soins personnels et les groupes de soutien dans le domaine de la santé chez les personnes âgées débute par la définition de ces deux approches et enchaîne avec une discussion de l'étendue de leur utilisation par les personnes âgées, les obstacles à la participation, et les façons d'adapter les groupes selon les besoins et les circonstances des personnes âgées. L'auteur examine également le fonctionnement des groupes et les résultats obtenus et recommande des avenues de recherche future et des façons d'optimiser à la fois l'attrait et l'efficacité de ces deux types de groupes d'assistance mutuelle.
Aims and objectives:
Hypothesised that sociodemographic factors and illness variables would be associated with mortality and that emotional and social loneliness measured using the Social Provisions Scale would influence mortality among nursing homes residents with cancer.
Background:
Studies are lacking on how emotional and social loneliness influence mortality among cognitively intact older people in nursing homes with and without a diagnosis of cancer.
Design:
A cross-sectional design was used at baseline with a five-year follow-up of mortality. Methods. A cohort of 227 cognitively intact (Clinical Dementia Rating scale score ≤0·5) older residents (60 with cancer and 167 without) from 30 nursing homes were followed from 2004-2005 to 2010. Data were collected by face-to-face interview. Sociodemographic variables and medical diagnoses were obtained from the records.
Results:
Survival did not differ significantly between residents with and without cancer. After adjustment for sociodemographic and illness variables, increasing age, higher education and comorbidity were associated with mortality. In the final model from a backward selection procedure, attachment (emotional loneliness) was associated with mortality.
Conclusions:
Independent of a cancer diagnosis or not, emotional loneliness, age, education and comorbidity influenced mortality among nursing homes residents without cognitive impairment.
Relevance to clinical practice:
Nurses should pay attention to emotional loneliness among nursing homes residents independent of cancer and especially give attention to the importance to have a close confidant who provides emotional support.
Murfield J, Cooke M, Moyle W, Shum D, Harrison S. International Journal of Nursing Practice 2011; 17: 52–59
Conducting randomized controlled trials with older people with dementia in long-term care: Challenges and lessons learnt
The characteristics of older people with dementia and the long-term care environment can make conducting research a challenge and, as such, this population and setting are often understudied, particularly in terms of clinical or randomized controlled trials. This paper provides a critical discussion of some of the difficulties faced whilst implementing a randomized controlled trial exploring the effect of a live music programme on the behaviour of older people with dementia in long-term care. A discussion of how these challenges were addressed is presented to aid investigators planning the design of similar research and help encourage a proactive approach in dealing with research-related challenges right from project conception. The article is structured according to the three principles of a randomized controlled trial in order to keep experimental rigour at the forefront of this research area.
Preventing and alleviating social isolation and loneliness among older people is an important area for policy and practice, but the effectiveness of many interventions has been questioned because of the lack of evidence. A systematic review was conducted to determine the effectiveness of health promotion interventions that target social isolation and loneliness among older people. Quantitative outcome studies between 1970 and 2002 in any language were included. Articles were identified by searching electronic databases, journals and abstracts, and contact-ing key informants. Information was extracted and synthesised using a standard form. Thirty studies were identified and categorised as 'group ' (n=17) ; ' one-to-one ' (n=10) ; 'service provision' (n=3) ; and ' community development ' (n=1). Most were conducted in the USA and Canada, and their design, methods, quality and transferability varied considerably. Nine of the 10 effective interventions were group activities with an educational or support input. Six of the eight ineffective interventions provided one-to-one social support, advice and information, or health-needs assessment. The review suggests that educational and social activity group interventions that target specific groups can alleviate social isolation and loneliness among older people. The effectiveness of home visiting and befriending schemes remains unclear.
Throughout the world, governments are restructuring social and welfare provision to give a stronger role to opportunity, aspiration and individual responsibility, and to competition, markets and consumer choice. This approach centres on a logic of individual rational action: people are the best judges of what serves their own interests and government should give them as much freedom of choice as possible. The UK has gone further than any other major European country in reform and provides a useful object lesson. This book analyses the pressures on social citizenship from changes in work and the family, political actors, population ageing, and the processes within government in the relentless international process of globalization that have shaped the response. It examines the various social science approaches to agency and argues that the logic of rational action is able to explain how reciprocity arises and is sustained but offers a weak foundation for social inclusion and social trust. It will only sustain part of the welfare state. A detailed assessment of empirical evidence shows how the outcomes of the new policy framework correspond to its theoretical strengths and limitations. Reforms have achieved considerable success in delivering mass services efficiently. They are much less successful in redistributing to more vulnerable low income groups and in maintaining public trust in the structure of provision. The risk is that mistrustful and disquieted voters may be unwilling to support high spending on health care, pensions and other benefits at a time when they are most needed. In short, the reform programme was undertaken for excellent reasons in a difficult international context, but risks throwing the baby out with the bathwater.
This study examines coresident relationships in assisted living (AL) and identifies factors influencing relationships.
We draw on qualitative data collected from 2008 to 2009 from three AL communities varying in size, location, and resident characteristics. Data collection methods included participant observation, and informal and formal, in-depth interviews with residents, administrators, and AL staff. Data analysis was guided by principles of grounded theory method, an iterative approach that seeks to discover core categories, processes, and patterns and link these together to construct theory.
The dynamic, evolutionary nature of relationships and the individual patterns that comprise residents' overall experiences with coresidents are captured by our core category, "negotiating social careers in AL." Across facilities, relationships ranged from stranger to friend. Neighboring was a common way of relating and often involved social support, but was not universal. We offer a conceptual model explaining the multilevel factors influencing residents' relationships and social careers.
Our explanatory framework reveals the dynamic and variable nature of coresident relationships and raises additional questions about social career variability, trajectories, and transitions. We discuss implications for practice including the need for useable spaces, thoughtful activity programming, and the promotion of neighboring through staff and family involvement.
Background:
Human rights and citizenship are concepts widely used in health and social care literature. However, they are applied less frequently and less rigorously in dementia care. This paper briefly presents these concepts before exploring how they have been applied to dementia care policy and practice. We highlight areas of dementia care where human rights can be violated and citizenship can be denied. We suggest reasons why people with dementia can be denied their human and civil rights and discuss how such concepts provide a way to address cultural and practice change in dementia care.
Aims and objectives:
To demonstrate how these concepts can be used to challenge and improve dementia care nursing.
Conclusions:
This paper contributes to emerging discussion about dementia care nursing by challenging conventional ways of understanding dementia and the care practices that result. Taking a rights-based approach allows nurses to examine inequity in services and address poor practice.
Implications for practice:
Looking at dementia through the lenses of citizenship and human rights provides a way to broaden the scope of contemporary dementia care nursing, to enable nurses to challenge inequity and to develop and improve the direct nursing care offered to people with dementia.
Few studies have examined the association between social support and loneliness among nursing home residents without cognitive impairment. The main aims of this study were to examine the frequency of contact and loneliness and the association between loneliness and the social support dimensions: attachment, social integration, reassurance of worth and opportunities for nurturance.
A cross-sectional, descriptive, correlational design.
All 30 nursing homes in the city of Bergen in western Norway.
A total of 227 long-term nursing home residents 65 years and older without cognitive impairment.
Data were obtained through face-to-face interviews using the global question "Do you sometimes feel lonely?", the Social Provisions Scale and one multiple-item question of the Family and Friendship Contacts Scale. Possible relationships between the Family and Friendship Contacts Scale, Social Provisions Scale and loneliness were analyzed using logistic regression while controlling for sex, age group, marital status, education, having a primary nurse, telephone contact and having hobby and interests.
In total, 56% experienced loneliness. No social support variable was significantly correlated with loneliness before adjusting for sociodemographic variables. Attachment was nearly statistically significant (P=0.07). When the sociodemographic variables (sex, children, age group, marital status, education, primary nurse, telephone contact, hobbies and Functional Comorbidity Index) were adjusted for, attachment was significant (P=0.03). The social support variables social integration, nurturance and reassurance of worth were not associated with loneliness. Among the sociodemographic variables, sex and marital status were significantly associated with loneliness (P<0.05).
Emotional closeness to significant others from which one derives a sense of security appears to be important for loneliness, and the frequency of contact with family and friends did not explain the experience of loneliness. Clinical nurses should recognize that social support is associated with loneliness and pay attention to the importance of social support for the residents in daily practice.
Public health is moving toward the goal of implementing evidence-based interventions. To accomplish this, there is a need to select, adapt, and evaluate intervention studies. Such selection relies, in part, on making judgments about the feasibility of possible interventions and determining whether comprehensive and multilevel evaluations are justified. There exist few published standards and guides to aid these judgments. This article describes the diverse types of feasibility studies conducted in the field of cancer prevention, using a group of recently funded grants from the National Cancer Institute. The grants were submitted in response to a request for applications proposing research to identify feasible interventions for increasing the utilization of the Cancer Information Service among underserved populations.