Practices countering resident-to-resident aggression and promoting wellness care for older adults in congregate residential facilities: results from a systematic review.

Resident-to-resident aggression (RRA) is an important issue in congregate residential facilities (CRFs) for older adults and has devastating effects. This study aimed to provide an inventory and content analysis of the practices used to counter RRA and promote wellness care for older adults in CRFs. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, original, peer-reviewed research and systematic reviews published in 14 electronic databases and two gray literature sources were examined. Of the 6196 articles identified, 28 met the inclusion criteria. Practices aimed to prevent, track or intervene in RRA, mostly in long-term care centers, but few were evidence-based and ready for widespread implementation. It emerges that continuous training of staff is necessary and that it should prioritize a person-centered approach. CRFs' managers must promote a culture of wellness care and policymakers should consider the prevention practices to improve the quality of life of older adults in CRFs.

Self-actualization and self-efficacy in the elderly in a ludic italian language learning program: a theoretical framework / O sentimento de autorrealização e de autoeficácia de idosos no aprendizado da língua italiana: quadro teórico

This article presents the conceptual framework developed for the study "Self-actualization and self-efficacy in the elderly in a ludic foreign language program." We explicate the theoretical grounds for the ludic teaching approach used in the Italian language learning program Pian, piano si va lontano. Based on the concept of ludicity, this serious leisure activity is a form of social participation that fosters self-actualization and hence feelings of self-efficacy in older learners. We conclude with some research avenues to gain a deeper understanding of the protective effects of bilingualism on cognitive functioning in the elderly and the role of a ludic teaching approach in enhancing these protective effects from a gerontagogical perspective.

Este artigo apresenta o quadro teórico desenvolvido no âmbito do estudo "O Sentimento de Autorrealização e de Autoeficácia de Idosos em um Programa de Aprendizado Lúdico da Língua Italiana". Explicamos os fundamentos teóricos para a metodologia de ensino lúdica usada no programa de aprendizagem de língua italiana Pian, piano si va lontano. Com base no conceito de ludicidade, essa atividade de lazer sério é uma forma de participação social que promove a autorrealização e, portanto, os sentimentos de autoeficácia em alunos idosos. Concluímos sugerindo alguns caminhos de pesquisa que possam obter uma compreensão mais profunda dos efeitos protetores do bilinguismo sobre o funcionamento cognitivo em idosos e o papel de uma metodologia de ensino lúdica para aumentar esses efeitos protetores de uma perspectiva gerontagógica.

Influence of Lifestyle Redesign® on Health, Social Participation, Leisure, and Mobility of Older French-Canadians.

IMPORTANCE: Developed in California to enable community-dwelling older adults to maintain healthy and meaningful activities, Lifestyle Redesign® is a well-known cost-effective preventive occupational therapy intervention. The impact of a newly adapted French version on older French-Canadians was, however, unknown. OBJECTIVE: To explore the influence of Lifestyle Redesign on older French-Canadians' health, social participation, leisure, and mobility. DESIGN: A mixed-methods design included a preexperimental component (questionnaires administered before and after the intervention and 3 and 6 mo postintervention) and an exploratory descriptive qualitative clinical study. Individual semidirected interviews were digitally audiotaped and transcribed, then underwent thematic content analysis using mix extraction grids. SETTING: Community. PARTICIPANTS: Sixteen volunteers (10 women) aged 65-90 yr (mean = 76.4, standard deviation = 7.6), 10 without and 6 with disabilities. Inclusion criteria were age ≥65 yr, normal cognitive functions, residence in a conventional or senior home, and French speaking. INTERVENTION: French-Canadian 6-mo version of Lifestyle Redesign. OUTCOMES AND MEASURES: Health, social participation, leisure, and mobility were measured using the 36-item Short Form Health Survey, Social Participation Scale, Leisure Profile, and Life-Space Assessment, as well as a semistructured interview guide. RESULTS: The French-Canadian Lifestyle Redesign had a beneficial effect on participants' mental health (p = .02) and interest in leisure (p = .02) and, in those with disabilities, social participation (p = .03) and attitudes toward leisure (p = .04). Participants reported positive effects on their mental health, leisure, mobility, and social participation, including frequency and quality of social interactions, and indicated that having an occupational routine fostered better health. None of the participants reported no effect. CONCLUSION AND RELEVANCE: The translated and culturally adapted Lifestyle Redesign is a promising occupational therapy intervention for community-dwelling older French-Canadians. WHAT THIS ARTICLE ADDS: This study sheds light on the influence of the French-Canadian version of the intervention not only on older adults' health and social participation but also on their leisure activities and life-space mobility, two important outcomes not addressed in previous Lifestyle Redesign studies. Moreover, this study provides an in-depth understanding of the Lifestyle Redesign experience of French-Canadian older adults with and without disabilities, including participants with significant communication and mobility disabilities.

Participation sociale et personnes ayant des atteintes cognitives et centre communautaire de loisir : une équation possible?

Validating support of social participation for people with cognitive impairment (CI) plays a predominant role in maintaining identity, autonomy, sense of belonging and social bonding. Yet what restricts this participation-intervention methods, cognitive impairment, or other individuals in the participant's environment? This study documents stakeholders', volunteers' and users' perceptions of people with CI in community recreation centres (CRC). Six focus groups (n = 44) in Montreal, Quebec City and Drummondville highlighted some issues concerning this subject. Although sympathetic to a society where people with multiple weaknesses coexist, participants are not convinced of the need to include those whose memory and judgment are failing. The integration of people with CI includes relational and organizational challenges and questions our relationship to cognitive aging and performance values in an inclusive environment.

Personalized citizen assistance for social participation (APIC): A promising intervention for increasing mobility, accomplishment of social activities and frequency of leisure activities in older adults having disabilities.

BACKGROUND: Social participation, a determinant of health in older adults, requires innovative interventions. The personalised citizen assistance for social participation (APIC) involves weekly three-hour personalised stimulation sessions targeting significant social and leisure activities difficult to accomplish. Recently adapted for older adults, the APIC's impact on this population is unknown. OBJECTIVE: This study explored the impact of APIC on older adults with disabilities. METHODS: A mixed-method design including a pre-experimental component was used with 16 participants (11 women) aged 66-91 (79.4±8.7) with disabilities, living at home. They completed functional autonomy, social participation, leisure and quality of life questionnaires, and semi-structured interviews. RESULTS: APIC increased older adults' functional autonomy (p=0.02), accomplishment (p<0.01) and satisfaction (p=0.02) with social participation, and frequency of leisure practice (p<0.01). Post-intervention, participants wished to modify the practice (p<0.01) and frequency (p<0.01) of leisure activities, and difficulties in their social environment diminished (p=0.03). Their attitude toward leisure (p=0.04) as well as their health (p<0.01) and psychological (p=0.03) quality of life improved. Older adults thought APIC helped them resume, maintain, explore and experiment with significant social activities. It also increased their psychological and physical well-being, feeling of control, connectedness, self-esteem and motivation to accomplish activities. Finally, APIC can compensate for an unavailable and crumbling social network. CONCLUSION: APIC is a promising intervention that leads to new opportunities for older adults to increase community integration and enhance the social component of their lives. It can also optimise how the needs of older adults are met, including utilisation of personal and environmental resources.

Participation needs of older adults having disabilities and receiving home care: met needs mainly concern daily activities, while unmet needs mostly involve social activities.

BACKGROUND: Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers. METHODS: A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods. RESULTS: Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility. CONCLUSIONS: This study highlights the complexity of older adults' participation needs, involving daily as well as social activities. Properly assessing and addressing these needs is thus necessary to improve older adults' health and well-being. Discrepancies in the various actors' perceptions of participation needs must be further explored. Additional research would help better understand how to optimize the contribution of community organizations and caregivers.

Effects of an adapted leisure education program as a means of support for caregivers of people with dementia.

The loss of autonomy associated with dementia affects the people with dementia themselves as well as their caregivers who are often left feeling powerless and incompetent in their caregiving role. Most of the programs developed to support caregivers focus on burden and do not consider the positive aspects of caregiving. Leisure represents a way to enhance the presence of positive aspects in the caring experience. Moreover, leisure might contribute to the maintenance of satisfactory relationships between the caregivers and the person with dementia. An adapted leisure education program was developed as a means of support to caregiver involvement. This study (n=49) aims to evaluate the impact of this program on caregivers' well-being, self-efficacy towards adapted leisure, and quality of the relationship with the care receiver. Mixed methods were used. Pretest-posttest with a follow-up design made up the quantitative part. In addition, open-end interviews (n=10) were conducted. The quantitative results showed few impacts of the program on caregivers. However, the qualitative analysis revealed that the intervention had positive impacts for the caregivers, care receivers and other family members. This study introduces caregiver support in a new, positive perspective by focusing on the positive aspects of caregiving rather than the burden.

[Development of an adapted leisure education program for persons with dementia]. / Développement d'un programme d'éducation au loisir adapté comme moyen de soutien à l'implication d'aidants d'un proche atteint de démence.

Leisure represents a positive way to keep relationships satisfactory between caregivers and a person with dementia. Adapted leisure education is a promising approach to assist the family to discover new ways to share good times with their relatives. This study aimed to develop an adapted leisure education program. It included an evaluation of the caregivers' needs, the program content development, and a pilot study to experiment with the content of the program. Three focus groups of dementia caregivers (n = 19) were conducted to investigate caregivers needs. Based on content analysis of these focus groups and a literature review, the content of the program was developed. The pilot study (n = 4) included a quasi-experimental trial and an implementation evaluation. This study led to the development of an adapted leisure education program that puts caregiver support in a new perspective, focusing on positive aspects rather than the burden of caregiving.

Effect of a home leisure education program after stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of a leisure education program on participation in and satisfaction with leisure activities (leisure-related outcomes), and well-being, depressive symptoms, and quality of life (primary outcomes) after stroke. DESIGN: Randomized controlled trial. SETTING: Home and community. PARTICIPANTS: Sixty-two people with stroke. INTERVENTION: Experimental participants (n=33) received the leisure education program at home once a week for 8 to 12 weeks. Control participants (n=29) were visited at home at a similar frequency. Participants were evaluated before and after the program by a blinded assessor. MAIN OUTCOME MEASURES: Change from preintervention to postintervention in: minutes of leisure activity per day, number of leisure activities, the Leisure Satisfaction Scale, the Individualized Leisure Profile, the General Well-Being Schedule (GWBS), the Center for Epidemiological Studies Depression Scale, and the Stroke-Adapted Sickness Impact Profile (SA-SIP30). RESULTS: There was a statistically significant difference in change scores between the groups for satisfaction with leisure with a mean difference of 11.9 points (95% confidence interval [CI], 4.2-19.5) and participation in active leisure with a mean difference of 14.0 minutes (95% CI, 3.2-24.9). There was also a statistically significant difference between groups for improvement in depressive symptoms with a mean difference of -7.2 (95% CI, -12.5 to -1.9). Differences between groups were not statistically significant on the SA-SIP30 (0.2; 95% CI, -1.3 to 1.8) and GWBS (2.2; 95% CI, -5.6 to 10.0). CONCLUSIONS: The results indicate the effectiveness of the leisure education program for improving participation in leisure activities, improving satisfaction with leisure and reducing depression in people with stroke.