Home Care Worker Continuity in Home-Based Long-Term Care: Associated Factors and Relationships With Client Health and Well-Being
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PROVIDER: S-EPMC10946305 | biostudies-literature | 2024 Jan
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Project description:The effects of a regular and graduated walking program as a stand-alone intervention for individuals in long-term care are unclear. Exercise and fall prevention programs typically studied in long-term care settings tend to involve more than one exercise mode, such as a combination of balance, aerobic, strengthening, and flexibility exercises; and, measures do not always include mental health symptoms and behaviors, although these may be of even greater significance than physical outcomes.We are randomly assigning residents of long-term care facilities into one of three intervention groups: (1) Usual Care Group--individuals receive care as usual within their long-term care unit; (2) Interpersonal Interaction Group--individuals receive a comparable amount of one-on-one stationary interpersonal interaction time with study personnel administering the walking program; and, (3) Walking Program Group--individuals participate in a supervised, progressive walking program five days per week, for up to half an hour per day. Assessments completed at baseline, 2 and 4 months during intervention, and 2 and 4 months post-intervention include: gait parameters using the GAITRite® computerized system, grip strength, the Berg Balance Scale, the Senior Fitness Test, the Older Adult Resource Services Physical Activities of Daily Living, the Geriatric Depression Scale Short Form, the Cornell Scale for Depression in Dementia, the Revised Memory and Behavior Problems Checklist, the Short Portable Mental Status Questionnaire, the Coloured Analogue Scale, pain assessment scales, and the number and nature of falls. Sophisticated data analytic procedures taking into account both the longitudinal nature of the data and the potential for missing data points due to attrition, will be employed.Residents in long-term care have a very high number of comorbidities including physical, mental health, and cognitive. The presence of dementia in particular makes standardized research protocols difficult to follow, and staff shortages, along with inconsistencies related to shift changes may impact on the accuracy of caregiver-rated assessment scales. Practical challenges to data collection validity and maintenance of inter-rater reliability due to the large number of research staff required to implement the interventions at multiple sites are also posed.ClinicalTrials.gov NCT01277809.
| S-EPMC3570356 | biostudies-literature
Project description:IntroductionCollaborative dementia care models with care navigation, including the Care Ecosystem, improve outcomes for persons living with dementia (PLWDs) and their caregivers. The effects of continuous care over long periods have not been studied.MethodsIn this randomized clinical trial with 456 PLWD-caregiver dyads with high caregiver burden, we evaluated the cumulative 5-year treatment effect on PLWD quality of life, health care utilization, caregiver depression, self-efficacy, and burden.ResultsFive-year participation was associated with higher quality of life, lower caregiver depression, and higher caregiver self-efficacy (all p's < 0.05) with a trend for lower burden (p = 0.07). Treatment effects were most robust during the first 2 years. The effects on emergency department visits and hospitalizations were not significant.DiscussionThe benefits of collaborative dementia care on PLWD quality of life and caregiver well-being are sustained for 5 years, and the dyads may experience the greatest benefit during the first 2 years.HighlightsCollaborative dementia care with care navigation was evaluated over 5 years using a randomized clinical trial. The care was associated with better quality of life for the person with dementia and well-being for the caregiver. The most robust treatment effects were in the first 2 years.
| S-EPMC11782176 | biostudies-literature
Project description:ObjectiveTo investigate changes in well-being measures for older Māori after moving from community to long-term care (LTC).MethodsWe undertook a retrospective cohort study of older Māori in New Zealand (NZ) who had received assessments for their health needs whilst living at home (interRAI-HC assessment) as well as a subsequent assessment after moving into a care facility (interRAI-LTCF). All interRAI-HC assessments from 01 July 2013 to 21 December 2018 were identified and matched to LTCF assessments that were undertaken at least 6 months later. Odds ratios (OR) and 95% confidence interval (CI) were calculated to determine the difference in proportion of variables of interest (indicative of movement, socialising, sleep and nutrition, alongside general physical and mental health status) between participants' HC and subsequent LTCF assessments.ResultsChanges in well-being measures were investigated among 1531 Māori (mean age 76.2 years, 61% female). Odds of having a fall (OR: 0.40 [95% CI 0.34, 0.48]), being lonely (OR: 0.13 [95% CI 0.09, 0.18]), sleeping difficulty (OR: 0.74 [95% CI 0.60, 0.91]) and fatigue (OR: 0.18 [95% CI 0.14, 0.23]) reduced on moving to LTC. However, the presence of depression (OR 3.96 [95% CI 2.58, 6.09]) and dependence with locomotion (OR 1.56 [95% CI 1.23, 1.97]) significantly increased when moving from home to LTC.ConclusionDespite some indicators of functional and health-related decline, significant improvements are also apparent across multiple domains of well-being. Further investigation of resident and family perceptions of well-being in association with a move to LTC is warranted.
| S-EPMC11671709 | biostudies-literature
Project description:Family relationships are enduring and consequential for well-being across the life course. We discuss several types of family relationships-marital, intergenerational, and sibling ties-that have an important influence on well-being. We highlight the quality of family relationships as well as diversity of family relationships in explaining their impact on well-being across the adult life course. We discuss directions for future research, such as better understanding the complexities of these relationships with greater attention to diverse family structures, unexpected benefits of relationship strain, and unique intersections of social statuses.
| S-EPMC5954612 | biostudies-literature
Project description:ObjectivesTo describe the experiences of patients with long-term conditions who are referred to and engage with a Link Worker social prescribing programme and identify the impact of the Link Worker programme on health and well-being.DesignQualitative study using semistructured interviews with thematic analysis of the data.InterventionLink Worker social prescribing programme comprising personalised support to identify meaningful health and wellness goals, ongoing support to achieve agreed objectives and linkage into appropriate community services.SettingInner-city area in West Newcastle upon Tyne, UK (population n=132 000) ranked 40th most socioeconomically deprived in England, served by 17 general practices.ParticipantsThirty adults with long-term conditions, 14 female, 16 male aged 40-74 years, mean age 62 years, 24 white British, 1 white Irish, 5 from black and minority ethnic communities.ResultsMost participants experienced multimorbidity combined with mental health problems, low self-confidence and social isolation. All were adversely affected physically, emotionally and socially by their health problems. The intervention engendered feelings of control and self-confidence, reduced social isolation and had a positive impact on health-related behaviours including weight loss, healthier eating and increased physical activity. Management of long-term conditions and mental health in the face of multimorbidity improved and participants reported greater resilience and more effective problem-solving strategies.ConclusionsFindings suggest that tackling complex and long-term health problems requires an extensive holistic approach not possible in routine primary care. This model of social prescribing, which takes into account physical and mental health, and social and economic issues, was successful for patients who engaged with the service. Future research on a larger scale is required to assess when and for whom social prescribing is clinically effective and cost-effective.
| S-EPMC5541496 | biostudies-literature
Project description:Background and objectivesInformation communication technologies (ICTs) can enhance older adults' health and well-being. Most research on the use of voice-activated ICTs by older adults has focused on the experiences of individuals living in the community, excluding those who live in long-term care homes. Given evidence of the potential benefits of such technologies to mitigate social isolation and loneliness, more research is needed about their impacts in long-term care home settings. With this in mind, we evaluated impacts and engagement of older adults with voice- and touchscreen-activated ICTs in one long-term care home in Canada.Research design and methodsInterviews were conducted with older adults who were provided with a Google Nest Hub Max and with staff as part of a larger implementation study. Participants completed semistructured interviews before the technology was implemented, and again at 6 and 12 months. The interviews were recorded, transcribed, and analyzed using thematic analysis techniques.ResultsWe found that residents primarily used the technologies to engage in self-directed digital leisure and to engage with others both in and outside the home, and that this in turn enhanced their comfort, pleasure, and social connectedness. We also identified ongoing barriers to their engagement with the technology, including both personal and structural factors.Discussion and implicationsOur findings suggest that implementation of voice-activated ICTs can bring added value to broader efforts to improve well-being and quality of life in long-term care by enhancing choice, self-determination, and meaningful relationships.
| S-EPMC11630282 | biostudies-literature
Project description:BackgroundLeadership is a key driver of health care worker well-being and engagement, and feedback is an essential leadership behavior. Methods for evaluating interaction norms of local leaders are not well developed. Moreover, associations between local leadership and related domains are poorly understood. This study sought to evaluate health care worker leadership behaviors in relation to burnout, safety culture, and engagement using the Local Leadership scale of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey.MethodsThe SCORE survey was administered to 31 Midwestern hospitals as part of a broad effort to measure care context, with domains including Local Leadership, Emotional Exhaustion/Burnout, Safety Climate, and Engagement. Mixed-effects hierarchical logistic regression was used to evaluate the relationships between local leadership scores and related domains, adjusted for role and work-setting characteristics.ResultsOf the 23,853 distributed surveys, 16,797 (70.4%) were returned. Local leadership scores averaged 68.8 ± 29.1, with 7,338 (44.2%) reporting emotional exhaustion, 9,147 (55.9%) reporting concerning safety climate, 10,974 (68.4%) reporting concerning teamwork climate, 7,857 (47.5%) reporting high workload, and 3,436 (20.7%) reporting intentions to leave. Each 10-point increase in local leadership score was associated with odds ratios of 0.72 (95% confidence interval [CI] 0.71-0.73) for burnout, 0.48 (95% CI 0.47-0.49) for concerning safety climate, 0.64 (95% CI 0.63-0.66) for concerning teamwork climate, 0.90 (95% CI 0.89-0.92) for high workload, and 0.80 (95% CI 0.78-0.81) for intentions to leave, after adjustment for unit and provider characteristics.ConclusionLocal leadership behaviors are readily measurable using a five-item scale and strongly associate with established domains of health care worker well-being, safety culture, and engagement.
| S-EPMC9974844 | biostudies-literature
Project description:Objectives:The individual burden of caring for one's relatives not only depends on care characteristics but is also related to contextual factors. The objective of this study is to determine whether regional formal long-term care provision is linked to the well-being of spousal caregivers introducing the concept of "control" as central pathway to explain this link. Method:We applied multilevel analysis using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from over 29,000 Europeans and 1,800 spousal caregivers located in 138 regions in 11 countries to analyze the effects of regional contexts on caregiver well-being. The provision of formal care in a region was measured by the number of long-term care beds in nursing and residential homes among the older population. Results:We found that spousal caregivers' well-being, measured in terms of life satisfaction, loneliness, and depression, was positively linked to the regional availability of formal care, which is partly due to higher perceived control in regions with more formal care provision. Discussion:Our results suggest that formal care supply is essential not only for care recipients but also for caregivers: perceived alternatives to the private care arrangement go along with greater well-being of informal caregivers.
| S-EPMC6018933 | biostudies-literature
Project description:Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004-17) and time diaries from Poland (2013), the U.S. (2006-16), the U.K. (2014-15) and France (2009-10), we examine differences between widowed and partnered older women in well-being and its development in widowhood. Most importantly, our analysis accounts for time use, an aspect which has not been studied previously. We trace the evolution of well-being of women who become widowed by comparing them with their matched non-widowed 'statistical twins' and examine the role of an exceptionally broad set of potential moderators of widowhood's impact on well-being. We confirm a dramatic decrease in mental health and life satisfaction after the loss of partner, followed by a slow partial recovery over a 5-year period. An extensive set of controls recorded prior to widowhood, including detailed family ties and social networks, provides little help in explaining the deterioration in well-being. Unique data from time-diaries kept by older women in several European countries and the U.S. tell us why: the key factor behind widows' reduced well-being is increased time spent alone.Supplementary informationThe online version contains supplementary material available at 10.1007/s10902-023-00622-w.
| S-EPMC9851896 | biostudies-literature
Project description:BackgroundThis study aims to describe the development, testing and optimization of a new standard instrument, the Consumer Quality Index (CQ-index) Long-term Care, for measuring client experiences with long-term care in the Netherlands.MethodsThree versions of the CQ-index questionnaires and protocols for study sampling and data collection were developed, designed for interviews with residents of nursing or residential care homes and postal surveys among representatives of psychogeriatric residents and homecare clients. From July to November 2006 a pilot study was conducted among 2,697 clients of 68 nursing or residential care homes, 2,164 representatives of clients in 57 psychogeriatric care institutions, and 1,462 clients of 19 homecare organizations. We performed psychometric analyses and descriptive analyses, and evaluated the pilot study.ResultsThe pilot study showed the feasibility and usability of the instruments, supported the multidimensionality of the questionnaires and showed first findings on client experiences and possibilities for quality improvement. Nine scales applied to all care settings: shared decision making, attitude and courtesy, information, body care, competence and safety of care, activities, autonomy, mental well-being, and availability of personnel. The pilot resulted in three optimized questionnaires and recommendations for nationwide implementation.ConclusionsThe CQ-index Long-term Care provides a good basis to investigate the quality of nursing homes, residential care homes and homecare from the clients' perspective. This standardized instrument enables a nationwide comparison of the quality of long-term care for the purpose of transparency and quality assurance.
| S-EPMC2907762 | biostudies-literature