Challenging behavior of nursing home residents during COVID-19 measures in the Netherlands.

OBJECTIVES: From the perspective of the nursing home (NH) practitioners, to gain understanding of (1) whether challenging behavior in NH residents changed during the COVID-19 measures, (2) whether the practitioners' involvement in the treatment of challenging behavior changed, (3) what can be learned from the experience of NH staff. METHODS: A mixed methods study with a survey in 323 NH practitioners (psychologists, elderly care physicians, nurse practitioners) in the Netherlands, and in-depth interviews in 16 NH practitioners. Nonparametric analyses were used to compare estimated proportions of residents with increased and with decreased challenging behavior. Content analyses were conducted for open-ended questions and in-depth interviews. RESULTS: Participants reported changes in challenging behavior with slightly higher proportions for increased (Q1/Mdn/Q3: 12.5%, 21.7%, 30.8%) than for decreased (8.7%, 14.8%, 27.8%, Z = -2.35, p = .019) challenging behavior. Half of the participants reported that their work load increased and work satisfaction worsened during the measures. Different strategies were described to respond to the effects of COVID-19 measures, such as video calls, providing special areas for residents to meet their loved ones, adjusting activities, and reducing the exposure to negative news. CONCLUSIONS: Because COVID-19 measures resulted in both increased and decreased challenging behavior in NH residents, it is important to monitor for their potential long lasting effects. Increased work load and worsened work satisfaction of the NH staff, together with the changes in type of challenging behavior, indicate that the harmful effects of the anti-pandemic measures should be taken seriously.

More information, less understanding: a randomized study on consent issues in neonatal research.

BACKGROUND: Valid consent for research requires comprehensive and understandable information to be disclosed to participants. The way that information is shared varies, but regulatory bodies usually determine style. Some reports have suggested that although information may be all-inclusive, it does little to support understanding. OBJECTIVE: To explore the impact of various information-sharing approaches on parents' understanding of a research study and the validity of their consent. METHODS: This was a randomized, controlled trial. Parents of immature but well infants admitted to a large tertiary NICU in Edinburgh, Scotland, were randomly assigned within 72 hours of their infant's admission to receive 1 of 2 information leaflets, with or without a standardized verbal explanation, for a hypothetical intensive care research study. The leaflets differed in length and in the amount of detail in which the study process, risks, benefits, and patient rights were described. A questionnaire was used to elicit understanding about the purpose of the research, design of the study, procedures involved, and the consent process. RESULTS: Forty-one parents participated in the study. Those who received the longer leaflet without verbal explanation gained only limited understanding of the purpose of the research. The procedures involved in the study were understood better by those who received the shorter leaflet. Issues relating to consent and study design were readily understood in all groups. Irrespective of documentation style, verbal explanation significantly improved understanding. Differences in understanding had little effect on whether a parent would enroll his or her infant into the study. CONCLUSIONS: Verbal explanation significantly enhances understanding of the research process for participants regardless of the style of written documentation. However, shorter written information may lead to better understanding than lengthy, more complex documentation.

Quality of Life in healthy old age: relationships with childhood IQ, minor psychological symptoms and optimism.

BACKGROUND: The aim of this study was to examine relationships in old age between Quality of Life (QoL), childhood IQ, current cognitive performance and minor psychological symptoms, and to estimate possible contributions to these relationships made by sex, education, socioeconomic deprivation, current living group, sex, and balance and 6m walk time. METHODS: We conducted a follow-up study on 88 community residents without dementia who were survivors of the Aberdeen City 1921 birth cohort. QoL was measured by the Schedule for the Evaluation of Individual QoL-Direct Weighting (SEIQoL-DW), current cognition by MMSE and Raven's Progressive Matrices (RPM), childhood IQ, minor psychological symptoms as assessed by the Hospital Anxiety and Depression Scale (HADS), and optimism by the Life Orientation Test (LOT); we included balance, 6m walk time and demographic data. RESULTS: QoL was better in men than in women. Women reported more anxiety and depression. QoL correlated significantly with current cognition measured by RPM, childhood intelligence, anxiety and depressive symptoms, optimism and balance. The best model to predict QoL relied on childhood intelligence (13.4% of the variance) and was improved by addition of HADS (8.8 %) and LOT (4.8 %). Other variables did not contribute to the prediction of QoL. CONCLUSION: In the absence of dementia, childhood IQ, HADS and LOT explain 26.9% of the variance in QoL as reported by community-resident old people. The direction of association between current anxiety and depressive symptoms and lower QoL is uncertain. Lower childhood IQ may contribute to coping less well with later life. Lower QoL is not an invariable concomitant of mild cognitive decline.