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The effect of volunteer-led activities on the quality of life of volunteers, residents, and employees of a long-term care institution: a cohort study

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Background : The COVID-19 pandemic primarily impacted long-term care facilities by restricting visiting and circulation, affecting the quality of life (QoL) of older adults living in these institutions. Volunteer activities, essential for older adults’ daily life, were also interrupted and potentially negatively impacted the QoL of older adults, volunteers themselves, and also employees in these institutions, although this three-fold effect was not yet investigated. In this context, this study aims to evaluate the impact of the return of volunteer-led activities in a long-term care institution on the QoL of older adult residents, employees, and volunteers. Methods : This study used a pre-test and post-test design within the same group. The first round of data collection was conducted before volunteer-led activities return and the second round after one month of return. The instrument used to assess QoL was the EUROHIS-QoL-8 scale. This study was conducted within a nursing home in São Paulo, Brazil, created in 1937 by members of the Israeli community living in Brazil. Volunteer-led activities were part of residents’ daily life before the COVID-19 pandemic, when these activities were interrupted for about 20 months. A total of 79 individuals participated in both rounds (pre and post), of which: 29 residents, 27 volunteers, and 23 employees of the long-term care institution. Results : Using a Wilcoxon signed-rank test, the analyses indicated improvements after the one month return in different QoL aspects for the three groups. Volunteers improved their personal relationships (Z -2.332, p< .05), residents their overall health (Z -2.409, p< .05) and employees in their overall QoL perception (Z -2.714, p< .05). Influencing factors for residents were the number of activities (3 or more), gender (male), and education (undergraduate/graduate). For employees, those who assumed additional activities due to the volunteer-led activities interruption had a significant impact on their overall QoL. Conclusions : Evidence from this study suggests that volunteers’ return positively impacted different QoL aspects for volunteers, residents, and employees.
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The effect of volunteer-led activities on the quality of life of
volunteers, residents, and employees of a long-term care
institution: a cohort study
Luisa Veras de Sandes-Guimarães ( luisa.guimaraes@online.uscs.edu.br )
Universidade Municipal de São Caetano do Sul https://orcid.org/0000-0001-6894-7784
Patrícia Carla dos Santos
Ministry of Health: Ministerio da Saude
Carla Patricia Grossi Palácio Alves
Hospital Israelita Albert Einstein
Carina Junqueira Cervato
Hospital Israelita Albert Einstein
Ana Paula Alves Silva
Hospital Israelita Albert Einstein
Eliseth Ribeiro Leão
Hospital Israelita Albert Einstein
Research Article
Keywords: Volunteers, Residential Facilities, Aged, Quality of Life, COVID-19.
Posted Date: July 15th, 2022
DOI: https://doi.org/10.21203/rs.3.rs-1670605/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.Read Full License
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Abstract
Background: The COVID-19 pandemic primarily impacted long-term care facilities by restricting visiting and circulation, affecting the
quality of life (QoL) of older adults living in these institutions. Volunteer activities, essential for older adults’ daily life, were also
interrupted and potentially negatively impacted the QoL of older adults, volunteers themselves, and also employees in these
institutions, although this three-fold effect was not yet investigated. In this context, this study aims to evaluate the impact of the
return of volunteer-led activities in a long-term care institution on the QoL of older adult residents, employees, and volunteers.
Methods: This study used a pre-test and post-test design within the same group. The rst round of data collection was conducted
before volunteer-led activities return and the second round after one month of return. The instrument used to assess QoL was the
EUROHIS-QoL-8 scale. This study was conducted within a nursing home in São Paulo, Brazil, created in 1937 by members of the
Israeli community living in Brazil. Volunteer-led activities were part of residents’ daily life before the COVID-19 pandemic, when these
activities were interrupted for about 20 months. A total of 79 individuals participated in both rounds (pre and post), of which: 29
residents, 27 volunteers, and 23 employees of the long-term care institution.
Results: Using a Wilcoxon signed-rank test, the analyses indicated improvements after the one month return in different QoL aspects
for the three groups. Volunteers improved their personal relationships (Z -2.332, p< .05), residents their overall health (Z -2.409, p< .05)
and employees in their overall QoL perception (Z -2.714, p< .05). Inuencing factors for residents were the number of activities (3 or
more), gender (male), and education (undergraduate/graduate). For employees, those who assumed additional activities due to the
volunteer-led activities interruption had a signicant impact on their overall QoL.
Conclusions: Evidence from this study suggests that volunteers’ return positively impacted different QoL aspects for volunteers,
residents, and employees.
1. Background
The COVID-19 pandemic severely affected older adults, one of the most vulnerable groups considering risk factors such as having a
lower immunity and the presence of chronic diseases or other comorbidities. Higher mortality rates due to the disease were reported
worldwide before the vaccine was made widely available, and older adults living in long-term care facilities (nursing homes or
residential care facilities) were even more vulnerable [1]. Several countries imposed restrictions on external visits and internal
activities to contain the spread of the disease [2–4], which was indeed more dangerous within institutions where highly susceptible
people were clustered in one place [1] and where higher mortality rates due to the disease were reported [5]. The lack of activities and
family visits affected the older adults living in these institutions worldwide, who were further isolated due to the demands of the
restrictive measures, presenting increased depressive symptoms and anxiety, reduced mental acuteness, physical capacity, well-being,
and quality of life due to the lack of social connectedness and other factors [6, 7].
These long-term care institutions and hospitals frequently count on the service of volunteers who perform several non-medical
activities associated with the older adults’ daily lives, such as walking, reading, befriending and talking, organizing entertainment and
socialization activities, and assisting in nutrition and hydration [2, 4, 8, 9]. Volunteers offer extra assistance and companionship to
residents, provide support to the employees (e.g., nurses, nutritionists, and physical therapists), and potentially improve the overall
quality of care [8, 10]. The literature presents extensive evidence on the effects of volunteer activity on the volunteers themselves,
especially when older adults are concerned (see [11] and [12] for literature reviews on the subject). Such effects include but are not
limited to improving life satisfaction, self-esteem, quality of life, physical health, psychological well-being, and reducing depressive
symptoms. Some studies also provide evidence for this effect in long-term care facilities or hospital environments, addressing the
benets from an institutional [8, 10, 13] and from the patients’ perspective [8, 14].
Few studies have analyzed the impacts of the volunteer activities interrupted due to the COVID-19 pandemic on healthcare
institutions, their patients, and volunteers, and reported increased staff workload [2] and negative impacts on the health and well-
being of older adult volunteers [15]. The literature in the context of long-term care institutions has reported residents with reduced
mental well-being [16], cognitive performance, quality of life [17], and functional decline [7]. To the best of our knowledge, no studies
have analyzed this impact in long-term care institutions considering the perspectives of volunteers, residents and employees of the
institutions. Hence, this study contributes to the existing literature by evaluating the impact of the return of volunteer activities in a
long-term care institution on the quality of life of older adult residents, employees, and volunteers.
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Quality of life (QoL) was selected as the outcome to be evaluated because volunteer-led activities in the long-term care institution
analyzed covered physical, emotional, and social aspects of older adults’ daily lives. QoL was never measured at the institution;
however, the activities developed by the volunteers may have enhanced residents’ well-being and overall QoL. In addition, volunteering
is suggested to lessen possible quality of life reductions, especially considering senior volunteers (+ 50) [12]. QoL is measured based
on the individuals’ perceptions (a subjective measure of well-being), focusing on their overall satisfaction or dissatisfaction with
different aspects of their lives, e.g., physical and mental/emotional well-being, social relationships, and environment [18]. A limited
number of studies have assessed the QoL of older adults living in long-term care facilities during the COVID-19 pandemics [5, 18]
using a pre-post intervention design such as in this study.
2. Methods
2.1. Study setting
This study was conducted within a nursing home in São Paulo, Brazil, created in 1937 by members of the Israeli community living in
Brazil. As of April 2022, the institution currently accommodates 114 elderly people aged from 63 to 105 years old who live in
individual rooms and rely on a multidisciplinary team of 269 professionals, including doctors, nurses, physiotherapists, nutritionists,
administrators, caregivers, hygiene, nutrition, and maintenance professionals.
The institution also counts on a team of 92 volunteers (April 2022), managed by the volunteer department, who conduct several
activities with the residents, contributing to their QoL and well-being. These activities include efforts to improve residents’ QoL in
terms of their physical (e.g., craftsmanship, manual work, oral art), emotional/psychological (e.g., memory project, beauty space,
Reiki) and social (games and entertainment, library, movie sessions, visiting of volunteers in the residents’ rooms) capacities.
Due to the COVID-19 pandemic, all the activities conducted by volunteers in the institution were entirely interrupted in March 2020 and
external visiting became restricted, but all other internal activities remained the same. Volunteers adapted and conducted two
activities remotely during this period, namely making phone calls to residents and establishing a video channel with curated content
and special remote activities. On-site volunteer-led activities resumed in November 2021 and were interrupted again in mid-January
2022 with the increased number of cases of the omicron variant of the new coronavirus.
2.2. Study design and sample
This study used a pre-test and post-test design within the same group (i.e., without a control group) to assess whether the return of the
volunteering activities affected the quality of life of residents, employees, and volunteers of the institution. To this end, an online form
was answered by participants before (October 2021) and after the volunteers returned (between mid-December 2021 and mid-January
2022). Details on the questionnaire and data collection are available in the next section.
The study population consisted of 121 elderly residents (admitted into the institution until November 2019), 119 employees (working
in the morning/afternoon shifts; hired until November 2019), and 65 volunteers (a subset of the total number of volunteers who were
able to return to the activities on November 2021).
Residents were included based on their Mini-Mental State Exam (MMSE) score [19]. The standard cut-off point recommended in the
literature is 24 points, but studies carried out in Brazil have shown the relevance of considering the education level to determine the
MMSE cut-off point [20, 21]. Therefore, we adopted the following cut-off points for this study: illiterate − 21; lower education − 22;
middle education − 23; higher education − 24. The nal sample of older adults included 30 people for the data collected before
volunteers returned (rst round) and 29 after the volunteers returned (second round; one of the residents had died). Convenience
sampling was used for employees and volunteers, with an online form sent via e-mail to all suitable participants with follow-up e-
mails every week for three weeks in each sampling round. The nal volunteer sample included 53 (rst round) and 27 individuals
(second round), and the employee sample included 68 (rst round) and 23 individuals (second round).
2.3. Data collection and instruments
This study used the EUROHIS-QoL-8 scale to measure the quality of life (QoL). This scale is derived from the WHOQoL-BREF
developed by the World Health Organization (WHO) and contains eight items to measure QoL: overall QoL, general health, energy,
daily life activities, self-esteem, relationships, nances, and home. All items are positively phrased and measured using a 5-point scale
[22]. The validity and reliability of the Brazilian version of the scale have been tested, conrming good psychometric properties to
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measure QoL in Brazilian populations [23, 24], with measured reliability (Cronbachs alpha) of 0.72 and 0.81, respectively. For this
study, the scale presented a Cronbach’s alpha of 0.837 (before) and 0.867 (after) and a McDonald’s omega of 0.862 (before) and
0.875 (after).
In addition to the EUROHIS-QoL-8 scale items, the questionnaire also contained questions concerning demography (age, gender,
education), volunteer-led activities in which residents participated (before and after), the number of hours volunteers worked per week
after the return (limited to 8 by the institution), whether the employee assumed additional activities due to volunteers absence and
open questions to express how the volunteer-led activities impacted their overall well-being and QoL. A pre-test of the questionnaire
was administered to 6 participants (2 from each group) to verify if items were correctly understood. Only a few modications to the
scale explanation were necessary to facilitate understanding.
Data was collected between October 1st and October 31st, 2021 (rst round, before volunteers returned) and between December 12th
and January 15th (second round, approximately one month after the volunteers returned). The RedCap online tool was used for data
collection because it is a robust and secure online survey tool that complies with Health Insurance Portability and Accountability Act
(HIPAA) standards. For residents, three of the researchers performed the data collection in person to ensure a correct understanding of
the questions and avoid problems with the usage of online tools. The online form was sent via e-mail to volunteers and employees by
the volunteer department and institution management, respectively, and follow-up e-mails were sent every week.
2.4. Data analysis
The data were analyzed using the SPSS 24 software (Statistical Package for Social Sciences Inc, IL, USA). Descriptive statistics
(number, percentage, mean, and standard deviation) were calculated for the numerical and categorical data. The outcome data (QoL
indicators) were tested for normality using the Shapiro-Wilk and Kolmogorov-Smirnov tests, but the results indicated a non-normal
distribution. Hence, the differences among the pre-post QoL indicators were analyzed using the Wilcoxon signed-rank nonparametric
test. The Wilcoxon test analyzes scores in the two moments (before and after volunteer return), ranks the differences among scores
and assigns a sign to this difference (positive, negative, or no difference). The percentage of cases allocated as positive, negative, or
with no difference are presented below to describe those who presented increased or reduced scores for each QoL indicator in the
scale. The signicance level considered was p < 0.05.
3. Results
3.1. Participant characteristics
A total of 79 respondents were included in this study and were distributed among three groups: 27 volunteers (41.5% of the target
population), 29 elderly residents (83% of the target population) and 23 employees (19.3% of the target population). Table1 presents
the participants’ characteristics regarding the demographic variables selected and other specic characteristics of the participants in
each group. The mean age of the volunteers was 60.59 (SD = 10.08), 92.6% were women, 85.2% had an undergraduate or graduate
degree, and the average hours of volunteering per week was 4.33 (SD = 1.78). The mean age of the residents was 84.62 (SD = 7.99),
65.5% were women, 55.2% had high school education, and the average MMSE test score was 27.03 (SD = 2.23). Residents could
participate in 11 activities led by volunteers. Thus, we divided the residents into two groups according to the median number of
activities in which they participated: (i) 0 to 2 activities (51.7%); (ii) 3 or more activities (48.3%). Lastly, the mean age of the employees
was 38.77 (SD = 7.58), 95.7% were women, and 61.9% had an undergraduate or graduate degree. In the rst-round employees were
asked if they assumed additional tasks due to volunteers’ absence, and in the nal sample (considering both rounds), 36.4% stated
that they did.
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Table 1
Summary of the participants’ characteristics
Volunteers Residents Employees
Mean ± SD Mean ± SD Mean ± SD
Age (years) 60.59 ± 10.08 84.62 ± 7.99 38.77 ± 7.58
Mini-mental (MMSE) test score 27.03 ± 2.23
Average hours of volunteering per week 4.33 ± 1.78
Volunteers Residents Employees
n % n % n %
Gender
Male 2 7.4 10 34.5 1 4.3
Female 25 92.6 19 65.5 22 95.7
Education level
Primary school 0 0.0 5 17.2 1 4.8
High/secondary school 4 14.8 16 55.2 7 33.3
Undergraduate/Graduate 23 85.2 8 27.6 13 61.9
Activities after return
0 to 2 activities - - 15 51.7 - -
3 or more activities - - 14 48.3 - -
Additional activities due to volunteer absence
Yes - - - - 8 36.4
No - - - - 14 63.6
Total 27 100 29 100 23 100
Note: one missing data (for the same record) on employees for education level and additional activities was not included in the
table.
Table2 presents the results comparing QoL scores for each scale indicator before and after the return of the volunteers using the
Wilcoxon signed-rank test. The analysis of positive and negative ranks indicates whether the participants presented a reduction or
increase in the QoL indicators after the volunteers returned to the institution for the period analyzed. For volunteers, indicators
presented more positive than negative ranks, except indicators 2 (overall health) and 7 (nancial resources). The only indicator that
presented a signicant difference in the score before and after volunteers’ return was personal relationships (p < 0.05), with 30% of
volunteers reporting improvements in this aspect after the return. Half of the QoL indicators for the residents presented higher positive
than negative ranks, but only overall health (p < 0.05) exhibited a signicant difference before and after, with 52% of residents
reporting improvements after volunteers’ return. Finally, for employees, ve indicators presented improvements in their perception;
however, only overall QoL had a signicant difference before and after (p < 0.05).
The following themes arose for each group when the comments in the open section of the questionnaire were analyzed, reinforcing
and amplifying the results mentioned above. Volunteers mostly mentioned three aspects: sense of usefulness (7 mentions), self-
realization by helping others (7 mentions), and relationship and sociability with residents and other volunteers (6 mentions).
Employees mostly mentioned three aspects: less work overload (6 mentions), return to normal routines (3 mentions) and reduced
demand in the sector (2 mentions). Residents’ comments varied, but some highlighted being able to do something outside of their
rooms, occupying their time with different activities and meeting people/breaking social isolation.
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Table3 presents the relevant control variables that inuence the QoL indicators and a statistically signicant difference before and
after volunteers returned. The indicators that were inuenced by the control variables were overall QoL (employees) and overall health
(residents).
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Table 2
EUROHIS-QoL-8 scores analyzes with Wilcoxon signed-rank statistics
Volunteers Residents Employees
n % Sum
of
Ranks
Z n % Sum
of
Ranks
Z n % Sum
of
Ranks
Z
1. How would
you rate your
quality of
life?
Negative
Ranks 3 11% 10.50 -1.100 7 24% 76.00 -0.791 0 0% 0.00 -2.714*
Positive
Ranks 5 19% 25.50 12 41% 114.00 8 35% 36.00
No
difference 19 70% - 10 34% - 15 65% -
2. How
satised are
you with your
health?
Negative
Ranks 6 22% 30.00 -0.277 3 10% 34.00 -2.409* 2 9% 10.50 -1.069
Positive
Ranks 4 15% 25.00 15 52% 137.00 6 26% 25.50
No
difference 17 63% - 11 38% - 15 65% -
3. Do you
have enough
energy for
everyday life?
Negative
Ranks 5 19% 30.00 -0.775 5 17% 31.00 -0.66 1 4% 3.00 -1.342
Positive
Ranks 7 26% 48.00 7 24% 47.00 4 17% 12.00
No
difference 15 56% - 17 59% - 18 78% -
4. How
satised are
you with your
ability to
perform your
daily living
activities?
Negative
Ranks 3 11% 10.50 -1.098 10 34% 88.00 -1.147 4 17% 26.50 -0.106
Positive
Ranks 5 19% 25.50 6 21% 48.00 6 26% 28.50
No
difference 19 70% - 13 45% - 13 57% -
5. How
satised are
you with
yourself?
Negative
Ranks 3 11% 9.00 -0.877 5 17% 51.50 -0.911 1 4% 7.00 -1.265
Positive
Ranks 4 15% 19.00 11 38% 84.50 6 26% 21.00
No
difference 20 74% - 13 45% - 16 70% -
6. How
satised are
you with your
personal
relationships?
Negative
Ranks 1 4% 3.50 -2.332* 8 28% 77.50 -0.051 4 17% 22.00 -0.587
Positive
Ranks 8 30% 41.50 9 31% 75.50 4 17% 14.00
No
difference 18 67% - 12 41% - 15 65% -
7. Have you
enough
money to
meet your
needs?
Negative
Ranks 4 15% 14.00 -0.816 12 41% 100.00 -1.767 4 17% 14.00 0.000
Positive
Ranks 2 7% 7.00 4 14% 36.00 3 13% 14.00
Note 1: one missing data (for the same record) on employees for education level and additional activities was not included in the
table.
Note 2: *p < .05. **p < .01.
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Volunteers Residents Employees
n % Sum
of
Ranks
Z n % Sum
of
Ranks
Z n % Sum
of
Ranks
Z
No
difference 21 78% - 13 45% - 16 70% -
8. How
satised are
you with the
conditions of
your living
place?
Negative
Ranks 5 19% 27.50 0.000 9 31% 81.00 -0.243 7 30% 37.00 -1.809
Positive
Ranks 5 19% 27.50 8 28% 72.00 2 9% 8.00
No
difference 17 63% - 12 41% - 14 61% -
Total 27 100 29 100 23 100
Note 1: one missing data (for the same record) on employees for education level and additional activities was not included in the
table.
Note 2: *p < .05. **p < .01.
The control variables that were relevant to explain the differences in the positive perceptions of the residents concerning their overall
health improvement after the volunteers returned were number of activities, gender, and education. The residents who performed three
or more activities, were of the male gender, and had undergraduate or graduate degrees were the ones for which the improvement in
overall health perception was signicant (Table3). The relevant variable inuencing the overall QoL perception of the employees was
their assuming additional activities after volunteer-led activities were interrupted in 2020. The effect on overall QoL was signicant
only for those who reported “yes”.
Table 3
Signicant differences before and after with control variables
Residents Employees
Activities during
the period Gender Education Assumed
additional
activities
0 to 2 3 or
more Male Female Primary Secondary Undergrad/Grad Yes No
How would you rate
your quality of life? - - - - - - - 0.046* 0.102
How satised are you
with your health? 0.221 0.020* 0.014* 0.161 0.257 0.160 0.046* - -
Note: *p < .05. **p < .01.
4. Discussion
This study showed the positive effects of the return of volunteering activities after the COVID-19 restrictions on different QoL aspects
for volunteers, residents, and employees of a long-term care institution. After 20 months without volunteer-led activities and with
family visiting restrictions, a one-month return brought benets for volunteers in their personal relationships, residents in their overall
health, and employees in their overall QoL perception. Other demographic and context-related factors also inuenced this outcome.
For instance, residents who participated in three or more volunteer-led activities, were of the male gender, and had undergraduate or
graduate education, reported a signicant positive impact on their overall health. Employees who reported to have assumed additional
activities due to the volunteer-led activities interruption had a signicant impact on their overall QoL.
Previous studies have reported benets of volunteering, especially for older adults, suggesting improved psychological well-being [25],
physical health [26], quality of life [27], mental health, and reduced depression symptoms [11]. Other studies have highlighted the
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importance of volunteering in forming social connections and meaningful social relationships [11, 12, 28]. This aligns with our result
of improved personal relationships after the volunteering experience, since this enhanced connection with others assists the
formation of new relationships and strengthens previous ones, such as family connections and community ties [28].
Studies suggest several benets from the perspective of employees of an institution receiving volunteers for both hospitals, reducing
costs and improving the overall quality of care [2, 10], and employees, reducing workload and care burden [8, 13]. Our ndings also
indicate that volunteers helped reduce some of the employees’ workload, increasing the overall QoL for those who assumed additional
activities during the period without volunteering activities. Although to our knowledge, no studies have reported the effect of
volunteering in long-term care facilities on the QoL of employees, one reported that volunteers reduced the emotional and physical
burden of the staff [13], which is somewhat aligned with QoL indicators.
The literature reports several benets from volunteer-led activities for individuals in hospital settings, mostly analyzing older adults as
the benetted individuals. Volunteers provide several activities that stimulate patients’ physical and cognitive capacities and are great
companions for listening and talking with patients. This special attention and person-centered care foster patients’ comfort,
happiness and well-being [8, 10, 13]. Our ndings suggest that volunteer-led activities positively impacted residents’ perceptions of
their overall health, specically concerning those who participated in three or more activities. A systematic review focused on the
effect of volunteers’ care on older adults also showed a positive impact of the volunteers on health outcomes (nutrition, falls and
delirium) [14]. Our ndings are also consistent with the activity theory of aging, which argues that the life satisfaction of older adults
is directly related to their level of activity and social interaction [29].
This study adds evidence supporting the positive outcomes of volunteering activities for the three groups studied (volunteers,
residents, employees) and provides two novel contributions. The rst novelty was analyzing the contributions of volunteer-led
activities to the three groups within a long-term care institution. The second was analyzing the effects of before and after the
volunteers returned from the COVID-19 restrictions on the QoL of the three groups. To the best of our knowledge, only one study had
analyzed the perspectives of patients, volunteers, and staff of volunteer-led interventions in the context of the Hospital Elder Life
Program (HELP) in the Netherlands, also providing evidence of the benets of this volunteer program for the three groups, but this was
reported before the COVID-19 pandemic [8]. However, our study adds that all groups beneted from the return of the volunteer
activities in different QoL aspects when compared with the period without these activities.
4.1 Limitations
This study had a few limitations. The response rate to the online survey (for volunteers and employees) was lower than expected in
the rst but especially in the second round, which may have generated a selection bias, once those who really enjoyed or really hated
volunteer-led activities were more prone to answering. In addition, this study did not include a control group to compare pre-post
effects of volunteers’ return, which may limit the results. Although the inclusion of a control group was possible with volunteers (who
are outside the institution), it would be very dicult to control and limit the interaction between volunteers, employees and residents in
the study setting, restricting the viability of the control group. Lastly, this study analyzed only a month of volunteer-led activities, which
is a short period to expect increased QoL for all indicators. The specic QoL improvements identied for the three groups may be
transformed into better overall QoL improvements in a longer period of analysis (considering all indicators in the scale) since longer
engagement may render long-term benets which could only be perceived in time. Hence, for future studies, we suggest including
different follow-ups (three months, six months, one year) to assess these changes in QoL over time.
5. Conclusion
Overall, this study found that volunteers’ return (after a long period of interruption given the COVID-19 pandemic) positively impacted
different QoL aspects for volunteers, residents, and employees. Residents were most affected considering their overall health
perception when participating in 3 or more volunteer-led activities. Employees were most affected in their overall QoL perception when
they assumed additional activities due to the prolonged interruption of volunteer-led activities. This study has practical implications
for long-term care facilities since it indicates that volunteer care and activities are benecial for these three groups, which may benet
the institutions overall quality of care. More research is needed, multicentric and with more participants, to determine the broader
applicability and conditions of this effect.
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Abbreviations
HIPAA
Health Insurance Portability and Accountability Act
MMSE
Mini-Mental State Exam
QoL
Quality of Life
SD
Standard Deviation
WHO
World Health Organization
Declarations
Ethics approval and consent to participate
This study was approved by the ethics committee of Hospital Israelita Albert Einstein (CAAE: 50202321.9.0000.0071). Participants
gave informed consent (written, in paper format for residents and electronic format for volunteers and employees) to participate in the
study before taking part.
Consent for publication
Not applicable
Availability of data and materials
The dataset used for this study is available from the
Figshare
repository, DOI: 10.6084/m9.gshare.19652898.
Competing interests
The authors declare that they have no competing interests.
Funding
This research was funded by the Volunteer Department of Sociedade Benecente Israelita Brasileira Albert Einstein (São Paulo,
Brazil).
Authors’ contributions
LVSG, PCS, and CJ conceptualized the study with input from ERL. CJ, CPCPA, and APAS were responsible for data acquisition. LVSG
and PCS did the statistical analysis. LVSG wrote the rst draft of the manuscript and ERL did the nal review. All authors contributed
to data interpretations, and critical revisions of the manuscript. All authors have read and approved the nal version of the
manuscript.
Acknowledgements
The authors would like to thank the support provided by individuals working in the long-term care institution analyzed, especially Nívia
Pires, Rosemeire Urbinati, and Kelly Giordano. A special thank you to Telma Sobolh for her support and Sandra Sandacz, who
mobilized and organized the volunteers’ return. We also thank all participants who contributed to this study for their time and effort.
References
1. Payne M, Ageism. Older People and COVID-19. In: Social Work in Health Emergencies. London: Routledge; 2022. pp.201–15.
2. Pickell Z, Gu K, Williams AM. Virtual volunteers: the importance of restructuring medical volunteering during the COVID-19
pandemic. Med Humanit. 2020;46:537–40.
Page 11/12
3. Gerritsen DL, Oude Voshaar RC. The effects of the COVID-19 virus on mental healthcare for older people in The Netherlands. Int
Psychogeriatr. 2020;32:1353–6.
4. Fearn M, Harper R, Major G, Bhar S, Bryant C, Dow B, et al. Befriending Older Adults in Nursing Homes: Volunteer Perceptions of
Switching to Remote Befriending in the COVID-19 Era. Clin Gerontol. 2021;44:430–8.
5. Savci C, Cil Akinci A, Yildirim Usenmez S, Keles F. The effects of fear of COVID-19, loneliness, and resilience on the quality of life
in older adults living in a nursing home. Geriatr Nurs (Minneap). 2021;42:1422–8.
. Bethell J, Aelick K, Babineau J, Bretzlaff M, Edwards C, Gibson J-L, et al. Social Connection in Long-Term Care Homes: A Scoping
Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19. J Am Med Dir Assoc.
2021;22:228–37.e25.
7. Cortés Zamora EB, Mas Romero M, Tabernero Sahuquillo MT, Avendaño Céspedes A, Andrés-Petrel F, Gómez Ballesteros C, et al.
Psychological and Functional Impact of COVID-19 in Long-Term Care Facilities: The COVID-A Study. Am J Geriatr Psychiatry.
2022;30:431–43.
. Steunenberg B, van der Mast R, Strijbos MJ, Inouye SK, Schuurmans MJ. How trained volunteers can improve the quality of
hospital care for older patients. A qualitative evaluation within the Hospital Elder Life Program (HELP). Geriatr Nurs (Minneap).
2016;37:458–63.
9. Ayton D, O’Donnell R, Vicary D, Bateman C, Moran C, Srikanth VK, et al. Psychosocial volunteer support for older adults with
cognitive impairment: development of MyCare Ageing using a codesign approach via action research. BMJ Open.
2020;10:e036449.
10. Hotchkiss RB, Unruh L, Fottler MD. The Role, Measurement, and Impact of Volunteerism in Hospitals. Nonprot Volunt Sect Q.
2014;43:1111–28.
11. Wilson J. Volunteerism Research. Nonprot Volunt Sect Q. 2012;41:176–212.
12. Anderson ND, Damianakis T, Kröger E, Wagner LM, Dawson DR, Binns MA, et al. The benets associated with volunteering among
seniors: A critical review and recommendations for future research. Psychol Bull. 2014;140:1505–33.
13. Blair A, Bateman C, Anderson K. “They take a lot of pressure off us”: Volunteers reducing staff and family care burden and
contributing to quality of care for older patients with cognitive impairment in rural hospitals. Australas J Ageing. 2019;38:34–45.
14. Saunders R, Seaman K, Graham R, Christiansen A. The effect of volunteers’ care and support on the health outcomes of older
adults in acute care: A systematic scoping review. J Clin Nurs. 2019;28:4236–49.
15. Grotz J, Dyson S, Birt L. Pandemic policy making: the health and wellbeing effects of the cessation of volunteering on older
adults during the COVID-19 pandemic. Qual Ageing Older Adults. 2020;21:261–9.
1. Giebel C, Hanna K, Marlow P, Cannon J, Tetlow H, Shenton J, et al. Guilt, tears and burnout—Impact of < scp > UK</scp > care
home restrictions on the mental well-being of staff, families and residents. J Adv Nurs. 2022;00:1–12.
17. Plangger B, Unterrainer C, Kreh A, Gatterer G, Juen B. Psychological Effects of Social Isolation During the COVID-19 Pandemic
2020. https://doi.org/101024/1662-9647/a000283. 2022. https://doi.org/10.1024/1662-9647/A000283.
1. Colucci E, Nadeau S, Higgins J, Kehayia E, Poldma T, Saj A, et al. COVID-19 lockdowns’ effects on the quality of life, perceived
health and well-being of healthy elderly individuals: A longitudinal comparison of pre-lockdown and lockdown states of well-
being. Arch Gerontol Geriatr. 2022;99:104606.
19. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the
clinician. J Psychiatr Res. 1975;12:189–98.
20. Melo DM de, Barbosa AJG. O uso do Mini-Exame do Estado Mental em pesquisas com idosos no Brasil: uma revisão sistemática.
Cien Saude Colet. 2015;20:3865–76.
21. Kochhann R, Varela JS, Lisboa CS, de M, Chaves. MLF. The Mini Mental State Examination: Review of cutoff points adjusted for
schooling in a large Southern Brazilian sample. Dement Neuropsychol. 2010;4:35–41.
22. Schmidt S, Mühlan H, Power M. The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural eld study. Eur J Public
Health. 2006;16:420–8.
23. Rocha NS da, Power MJ, Bushnell DM, Fleck MP. The EUROHIS-QOL 8-Item Index: Comparative Psychometric Properties to Its
Parent WHOQOL-BREF. Value Heal. 2012;15:449–57.
Page 12/12
24. Pires AC, Fleck MP, Power M, da Rocha NS. Psychometric properties of the EUROHIS-QOL 8-item index (WHOQOL-8) in a Brazilian
sample. Rev Bras Psiquiatr. 2018;40:249–55.
25. Yang J, Matz-Costais C. A Latent Deprivation Perspective: Mechanisms Linking Volunteering to Mental Health in Later Life. Int J
Aging Hum Dev. 2020;:009141502095976.
2. Hong SI, Morrow-Howell N. Health outcomes of Experience Corps ®: A high-commitment volunteer program. Soc Sci Med.
2010;71:414–20.
27. Wahrendorf M, Siegrist J. Are changes in productive activities of older people associated with changes in their well-being? Results
of a longitudinal European study. Eur J Ageing. 2010;7:59–68.
2. Worker SM, Espinoza DM, Kok CM, Go C, Miller JC. Volunteer Outcomes and Impact: The Contributions and Consequences of
Volunteering in 4-H. J Youth Dev. 2020;15:6–31.
29. Knapp MRJ. The Activity Theory of Aging An Examination in the English Context. Gerontologist. 1977;17:553–9.
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