Understanding How and Why Alcohol Interventions Prevent and Reduce Problematic Alcohol Consumption among Older Adults: A Systematic Review.

Problematic alcohol use has been increasing in older adults (55+) in recent decades. Many of the effective interventions that are available to prevent or reduce the negative effects of alcohol consumption are aimed at adults in general. It is unclear whether these interventions also work for older adults. The objective of this review was to understand how (i.e., which elements), in which context, and why (which mechanisms) interventions are successful in preventing or reducing (problematic) alcohol consumption among older adults. A systematic review of articles published between 2000 and 2022 was performed using PubMed, PsycINFO, Web of Science and CHINAHL. Realist evaluation was used to analyze the data. We found 61 studies on interventions aimed at preventing or reducing problematic alcohol use. Most of the interventions were not specifically designed for older adults but also included older adults. The findings of the current study highlight three major effective elements of interventions: (1) providing information on the consequences of alcohol consumption; (2) being in contact with others and communicating with them about (alcohol) problems; and (3) personalized feedback about drinking behavior. Two of these elements were also used in the interventions especially designed for older adults. Being in contact with others and communicating with them about (alcohol) problems is an important element to pay attention to for developers of alcohol interventions for older adults because loneliness is a problem for this age group and there is a relationship between the use of alcohol and loneliness.

Exploring how residential care facilities can enhance the autonomy of people with dementia and improve informal care.

BACKGROUND AND OBJECTIVES: Residential care facilities (RCFs) strive to enhance autonomy for people with dementia and to enhance informal care provision, although this is difficult. This study explored how RCF staff can enhance autonomy and improve informal care by looking at the influence of interactions (contact and approachability between residents, staff members and informal caregivers) and the physical environment, including the use of technologies. RESEARCH DESIGN AND METHODS: A realist evaluation multiple-case study was conducted using document analyses, eight semi-structured interviews with staff members and relatives and 56 hours of observations of residents across two RCFs aiming to provide person-centred care. Realist logic of analysis was performed, involving Context-Mechanism-Outcome configurations. FINDINGS: The behaviour, attitudes and interactions of staff members with residents and informal caregivers appeared to contribute to the autonomy of people with dementia and enhance informal care provision. The physical environment of the RCFs and the use of technologies were less relevant to enhancing autonomy and informal care provision, although they can support staff members in providing person-centred care in daily practice. DISCUSSION AND IMPLICATIONS: The findings add to those of other studies regarding the importance of interaction between residents, staff members and informal caregivers. The findings provide insight for other RCFs on how successfully to enhance autonomy for their residents and to improve informal care provision, as well as, more broadly, how to implement person-centred care.

How staff characteristics influence residential care facility staff's attitude toward person-centered care and informal care.

BACKGROUND: Staff members, and their attitudes, are crucial for providing person-centered care in residential care facilities for people with dementia. However, the literature on the attitudes of nursing staff regarding person-centered care is limited. The objective of this study is to explore the association between staff characteristics (age, education level, years of work experience and function, i.e., care or welfare) and staff attitudes toward perceived person-centered care provision and including informal caregivers in the caregiving process in residential care facilities. METHODS: A convenience sample of 68 care staff - nurses and nurse assistants - welfare staff members - activity counselors, hostesses, and living room caretakers - of two residential care facilities filled out a questionnaire. Staff attitudes regarding perceived person-centered care were measured with the Person-centered Care Assessment Tool (P-CAT). Staff attitudes regarding informal care provision were measured with the Attitudes Toward Families Checklist (AFC). Multiple linear regression analysis explored the association between variables age, work experience, education, and function (care or welfare). RESULTS: A higher age of staff was associated with a more negative attitude toward perceived person-centered care and informal care provision. Welfare staff had a more negative attitude toward the inclusion of informal caregivers than care staff. The perceived person-centered care provision of the care and welfare staff was both positive. Work experience and education were not associated with perceived person-centered care provision or informal care provision. CONCLUSION: This study is one of the first to provide insight into the association between staff characteristics and their attitude toward their perceived person-centered care provision and informal care provision. A higher age of both the care and welfare staff was associated with a more negative attitude toward their perceived person-centered care and informal care provision. Welfare staff had a less positive attitude toward informal care provision. Additionally, future studies, also observational studies and interview studies, are necessary to collect evidence on the reasons for negative attitudes of older staff members towards PCC and informal care giving, to be able to adequately target these reasons by implementing interventions that eliminate or reduce these negative attitudes.

Coping Strategies Used by Older Adults to Deal with Contact Isolation in the Hospital during the COVID-19 Pandemic.

Due to the COVID-19 pandemic, many older adults have experienced contact isolation in a hospital setting which leads to separation from relatives, loss of freedom, and uncertainty regarding disease status. The objective of this study was to explore how older adults (55+) cope with contact isolation in a hospital setting during the COVID-19 pandemic in order to improve their physical and psychological wellbeing. The realist evaluation approach was used to formulate initial program theories on coping strategies used by (older) adults in an isolation setting. Twenty-one semi-structured interviews with older patients (n = 21) were analysed. This study revealed that both emotion-focused coping strategies as well as problem-focused coping strategies were used by older adults during contact isolation. The study also uncovered some new specific coping strategies. The results have useful implications for hospital staff seeking to improve the wellbeing of older adults in contact isolation in hospitals. Problem-focused coping strategies could be stimulated through staff performing care in a person-centred way. Trust in staff, as part of emotion-focused coping strategies, could be stimulated by improving the relationship between patients and staff.

[Perspectives of stakeholders on technology use in the care of community-living older adults with dementia]. / Perspectieven van stakeholders over het gebruik van technologie in de zorg voor thuiswonende ouderen met dementie.

Although technology has the potential to promote aging in place among community-living older adults with dementia, the use remains scarce. In this literature study we provide an overview of perspectives (i.e., needs, wishes, attitudes, possibilities, and difficulties) of different stakeholders on technology use in the care for community-living older adults with dementia. After selection, 46 studies were included. We mainly found perspectives of informal caregivers and, to a lesser extent, of persons with dementia and formal caregivers. Shared perspectives were, among other things, ease of use, stability and flexibility of technology, importance of privacy, and confidentiality. Among older adults, fun and pleasure, in addition to enhancing freedom and independence, facilitates technology use. Informal caregivers' peace of mind and relief of burden also appeared to be important in using technologies. Formal caregivers value the potential of technologies to improve monitoring and communication. Insight in perspectives of stakeholders are essential to enhance the use of technology in the care for community-living older adults with dementia.

How Can Autonomy Be Maintained and Informal Care Improved for People With Dementia Living in Residential Care Facilities: A Systematic Literature Review.

BACKGROUND AND OBJECTIVES: For people with dementia living in residential care facilities, maintaining autonomy and receiving informal care are important. The objective of this review is to understand how caregiving approaches and physical environment, including technologies contribute to the maintenance of autonomy and informal care provision for this population. RESEARCH DESIGN AND METHODS: A literature review of peer-reviewed articles published between January 1995 and July 2017 was performed. Realist logic of analysis was used, involving context, mechanism and outcome configurations. RESULTS: Forty-nine articles were included. The improvement of the relationship between residents and formal/informal caregivers is important. This increases the knowledge (sharing) about the resident and contributes to their autonomy. A social, flexible, and welcoming attitude of the formal caregiver improves the provision of informal care. Specially designed spaces, for instance, therapeutic gardens, create activities for residents that remind them of themselves and contribute to their autonomy. Use of technologies reduces caregiver's time for primary tasks and therefore enables secondary tasks such as interaction with the residents. DISCUSSION AND IMPLICATIONS: The results revealed how residential care facilities could maintain autonomy of their residents and improve informal care delivery using caregiving approaches and the physical environment including technologies. The results are supporting toward each other in maintaining autonomy and also helped in enhancing informal care provision. For residential care facilities that want to maintain the autonomy of their residents and improve informal care delivery, it is important to pay attention to all aspects of living in a residential care facility.