A Personalized Music Intervention in Nursing Home Residents Living With Dementia: Findings From a Randomized Study.

Utilizing a randomized control design, this mixed method study aimed to assess the impact of a personalized music intervention on mood, agitation level, and psychotropic drug use in individuals with moderate to advanced dementia residing in long-term care facilities. The sample comprised of 261 participants, with 148 in the intervention group and 113 in the control group. Data were collected from three sources: quantitative data from the Minimum Data Set and the Cohen-Mansfield Agitation Inventory, observational data of music-listening sessions, and an administrator survey regarding the lead staff person's perceptions of the intervention. Findings, based on Mixed Effect Models and content analyses, revealed positive impacts of the personalized music intervention on residents living with dementia. This low-cost, easily implementable intervention, requiring no special licensure for administration, can significantly enhance the quality of life for nursing facility residents.

Mason Caregivers Aiming for Resilience, Empowerment, and Support Study: Assessing Family Caregiver Burden Post-Intervention.

Background: Family caregivers of older adults living with dementia are known to experience higher burden levels. Methods: This empirical study conducted a sub-group analysis of burden levels of 97 family caregivers by the dementia severity of care recipients. Family caregivers were assessed before and after the 9-week Stress-Busting Program for Family CaregiversTM (SBP). Results: Family caregivers of older adults living with severe dementia had the highest baseline Zarit Burden Interview (ZBI) score of 27.7 which decreased to 25.0 (p < .05); family caregivers of those living with moderate dementia had a baseline ZBI score of 24.3 which decreased to 20.4 (p < .01); and family caregivers of those living with mild dementia had the lowest baseline ZBI score of 21.0, which decreased to 18.0 (p < .01). Conclusion: The SBP intervention was associated with a 15% reduction in burden scores for family caregivers of older adults living with dementia.

Community arts engagement supports perceptions of personal growth in older adults.

PURPOSE: The effects of arts engagement on older adults have been well-documented. However, the ways older adults overcome common situational and dispositional barriers to enhance personal growth and well-being are less known. METHODS: Fifty-six community dwelling older adults (71.3 ± 4.6 years) took part in dance, music, or a control workshop two times/week for ten weeks. Participants' personal growth was examined through focus groups and surveys in this mixed-methods study. RESULTS: Focus group and survey results revealed participants experienced personal growth through engaging in the dance and music arms of the experiment. Participants, especially those in arts workshops, described personal growth experiences aligning with four themes: increased social connections, developed new skills, utilized a growth mindset, and used creativity to overcome situational and dispositional barriers to participation. The barriers included musculoskeletal challenges, hearing impairments, and difficulty retaining new information. CONCLUSIONS: The study yielded high adherence and retention rates, and participants reported increased engagement within their communities. Our observations provide avenues for future practitioners and facilitators to create programming that empowers older adults and utilizes participants' ongoing feedback to support access, inclusion, and sense of community.

Characteristics of Nursing Facilities and Staff Willingness to Implement a Non-Pharmacological Intervention.

While non-pharmacological interventions could positively impact mood and behaviors of nursing-home residents who are living with dementia, some facilities are more willing to adopt such interventions than others. This study investigated the characteristics of Medicaid-funded nursing facilities that were associated with their willingness to implement a non-pharmacological intervention, personalized music. Using the publicly-available dataset (aka LTCfocus) from Brown University, this study examined characteristics of nursing homes in Virginia that have implemented or are in the process of implementing a personalized music intervention (n = 59) and that have decided not to implement it (n = 216). The findings indicate that nursing facilities with a higher proportion of long-term residents are more likely to implement the intervention. The findings can inform future research recruitment strategies. In addition, a greater understanding of the use of non-pharmacological interventions in relation to the characteristics of nursing facilities offers insight to policymakers and public health officials regarding resource allocations to facilities.

Dance, Music, and Social Conversation Program Participation Positively Affects Physical and Mental Health in Community-Dwelling Older Adults: A Randomized Controlled Trial.

INTRODUCTION: As the world population ages, practitioners use community-engaged interventions to help older adults stay healthy. Engaging in arts programs (e.g., dance or music) reportedly improves physical and mental health, but little research exists examining these effects in community-dwelling older adults. Our purposes were to examine how taking part in 10-week, twice per week community arts programs (dance and music) and control (social conversation) affected physical and mental health in community-dwelling older adults and their perceptions after program participation.
Methods: In this randomized controlled trial, 64 older adults over 65 years of age (71.3 ± 4.6 years, 166.9 ± 8.3 cm, 78.1 ± 18.1 kg) took part in community-engaged arts programs: ballroom dance (n = 23), music (ukulele-playing, n = 17), or control (social conversation n = 24), two times per week for 10 weeks. Participants' physical health using the Short Physical Performance Battery (SPPB; score 0 = worst to 12 = best) and mental health using the Montreal Cognitive Assessment (MoCA; score = 0 to 30, where less than 26 = normal) were tested three times: 1. before (pre), 2. at the end of 10 weeks (post-1), and 3. 1 month after intervention (post-2). Separate 3 (group) x 3 (time) ANOVAs and adjusted Bonferroni pairwise comparisons as appropriate examined changes across groups and time. Focus group interviews and surveys were audio recorded, transcribed, and analyzed using inductive thematic analyses to examine participants' perceptions.
Results: Across all groups, participants had an 87.8% attendance and an 87.5% retention rate. Participants' SPPB performance improved over time (pre = 10.5 ± 1.4, post-1 = 10.7 ± 1.3, post-2 = 11.3 ± 1.0; p < 0.001), but similarly across groups (p = 0.40). Post-hoc analyses revealed that performance improved from pre to post-1 (p = 0.002) and pre to post-2 (p < 0.001). Participants' cognition improved over time (pre = 26.3 ± 2.8, post-1 = 27.3 ± 2.6, post-2 = 27.5 ± 2.5, p < 0.001), and similarly across groups (p = 0.60). Post-hoc analyses revealed that cognition improved from pre- to post-1 (p = 0.002), and pre- to post-2 (p = 0.001). Participants consistently mentioned increased social engagement as the major reason for participation.
Conclusions: Overall, taking part in community-engaged arts (dance and music) and social conversation programs positively influenced physical and mental health in older adults. Still, as all groups improved equally, the results may partly be due to participants having normal physical and mental function pre-participation and due to them learning the test over time. These study findings imply that providing fun and free community-engaged programs that empower participants to be more engaged can positively influence physical and mental health and promote successful aging in older adults.

Creating Interprofessional Readiness to Advance Age-Friendly U.S. Healthcare.

A successful interprofessional faculty development program was transformed into a more clinically focused professional development opportunity for both faculty and clinicians. Discipline-specific geriatric competencies and the Interprofessional Education Collaborative (IPEC) competencies were aligned to the 4Ms framework. The goal of the resulting program, Creating Interprofessional Readiness for Complex and Aging Adults (CIRCAA), was to advance an age-friendly practice using evidence-based strategies to support wellness and improve health outcomes while also addressing the social determinants of health (SDOH). An interprofessional team employed a multidimensional approach to create age-friendly, person-centered practitioners. In this mixed methods study, questionnaires were disseminated and focus groups were conducted with two cohorts of CIRCAA scholars to determine their ability to incorporate learned evidence-based strategies into their own practice environments. Themes and patterns were identified among transcribed interview recordings. Multiple coders were used to identify themes and patterns and inter-coder reliability was assessed. The findings indicate that participants successfully incorporated age-friendly principles and best practices into their own work environments and escaped the silos of their disciplines through the implementation of their capstone projects. Quantitative data supported qualitative themes and revealed gains in knowledge of critical components of age-friendly healthcare and perceptions of interprofessional collaborative care. These results are discussed within a new conceptual framework for studying the multidimensional complexity of what it means to be age-friendly. Our findings suggest that programs such as CIRCAA have the potential to improve older adults' health by addressing SDOH, advancing age-friendly and patient-centered care, and promoting an interprofessional model of evidence-based practice.

Culturally Responsive Companion Program for a Japanese Woman with Dementia in a U.S. Nursing Home.

The older foreign-born population is predicted to increase in the United States. As a whole, this population in the long-term care setting is more likely to face greater challenges associated with loneliness and social isolation due to their smaller social networks, language and cultural differences. The benefits of person-centered care have been widely recognized and may be a potential remedy for such challenges felt by older immigrants. Using a qualitative case study approach, this study explored the staff perceptions of a culturally responsive companion program provided to an older Japanese woman with advanced dementia in the long-term care setting to understand the potential benefits of such a program. The first theme that emerged was that the client benefitted from the program in regard to her physical wellbeing, emotional wellbeing, language communication and cultural support. Given the support of Japanese companions, the client was able to express her needs and health symptoms effectively and the staff were subsequently able to provide culturally-sensitive care. The second theme that emerged was the perceived benefits received by the staff. The companion program improved the staff's ability to provide quality care for the resident. This study implies that culturally responsive companion programs may benefit foreign-born older individuals in improving their wellbeing in long-term care settings.

Compounding Complexity: Examining Multiple Factors Leading to Challenges Within Grandfamilies.

BACKGROUND AND OBJECTIVES: Grandparents who are raising their grandchildren in the absence of the biological parents, often referred to as custodial grandparents, are prevalent across the United States. The objective of this project was to establish a grounded theory as a tool for practitioners and researchers to understand the experiences of members of grandfamiles. RESEARCH DESIGN AND METHODS: In-depth, unstructured interviews with custodial grandparents and grandchildren from 15 grandfamilies were conducted. Classic grounded theory was the methodology used to ask the question, "What are the challenges within grandfamilies and how do they respond to these challenges?" RESULTS: The theory emerging from the data, Compounding Complexity, provides an explanatory framework of three interrelated categories of factors that affect complexity in grandfamilies: situational, relationship, and emotional complexity. Conflict and change were found to be consistent across the categories of Compounding Complexity. DISCUSSIONS AND IMPLICATIONS: Next steps include adding data from interviews with biological parents to Compounding Complexity and applying the theory. Understanding relationship, situational, and emotional complexity in the context of conflict and change enables practitioners to advance their work with grandfamiies.

A web-based training program for direct care workers in long-term care communities: Providing knowledge and skills to implement a music and memory intervention.

As dementia increases and the availability of at-home caregivers decreases, the need grows for effective training for direct care workers. Direct care workers have demanding schedules with restrictive availability and lack professional incentives to pursue specialized training. This study explored the impact of the Mason Music & Memory Initiative (M3I), a web-based, micro-learning training for direct care workers, combined with the implementation of the Music & Memory intervention. The training provided a foundational understanding of dementia and the person-centered music intervention. Twenty-five direct care workers, across two long-term care communities, completed the training modules over four weeks. All participants completed a pre- and posttest, determining their knowledge and understanding of dementia and the Music & Memory intervention adopted by their facilities. Many workers found the training to be informative and inspiring, noting improved behaviors in residents during the implementation of the M3I.

Results from a person-centered music intervention for individuals living with dementia.

AIM: Dementia is a chronic, costly disease affecting millions of people worldwide. Effective, affordable person-centered interventions are required to improve the lived experiences of individuals with dementia and their caregivers in various care settings. The present study examined the effects of a person-centered music listening intervention on mood, agitation and social engagement for individuals living with dementia. METHODS: This quasi-experimental study was carried out with participants at five community-based adult day health centers (n = 51). Standardized instruments were used to measure mood and agitation, and in-person and video-recorded observations of participant behavior were used to analyze changes before, during and after the intervention across four domains: mood, agitation, connecting to music and engaging socially. Within-person differences were examined using the Wilcoxon signed rank test, and between-group differences were examined using the Mann-Whitney U-test. RESULTS: Although standardized instruments did not yield statistically significant results, the behavioral observations showed a positive change in mood and a decrease in agitation. From pre- to post-intervention, there were statistically significant increases in joy, eye contact, eye movement, being engaged and talkativeness, and a decrease in sleeping and moving or dancing. CONCLUSIONS: Behavioral observations show the positive impact a person-centered music listening intervention might have on individuals living with dementia and attending adult day health centers. This affordable intervention provides a useful tool for caregivers that might improve the day-to-day experience of individuals living with dementia. Geriatr Gerontol Int 2019; 19: 30-34.

Advance Directives Information Delivery in Medicare/Medicaid-Funded Agencies: An Exploratory Study.

To encourage citizens to plan their end-of-life care to protect their autonomy, Congress passed the Patient Self-Determination Act (PSDA) in 1990. Under the PSDA, all Medicare/Medicaid-funded agencies are required to ask if all the patients, upon admission, have advance directives (ADs). If they have not formulated an AD, agencies need to inform that they have a right to do so and provide them with the written information. Although this is required by law, there is no universal procedure or set standard approach to deliver the information to patients in these agencies. It is often unclear who provides and explains information on ADs, and what materials are provided. The purpose of this study was to understand the procedures and challenges presented in the delivery of information about ADs in agencies in response to the PSDA requirements. Using a case study approach, semi-structured interviews with personnel in nine agencies were analyzed and three overarching themes were identified: organizational procedures, staff interactions, and staff perceptions. The findings indicated that there is a need for AD-specific training for staff responsible for delivering AD information to their clients. Implementation of a formalized procedure/guidelines for information delivery would be helpful to maintain quality standards across agencies.

Perceptions of professionalism among nursing faculty and nursing students.

Although there is no consensus about the definition of professionalism, some generally recognized descriptors include knowledge, specialization, intellectual and individual responsibility, and well-developed group consciousness. In this study, Q-methodology was used to identify common viewpoints about professionalism held by nursing faculty and students, and four viewpoints emerged as humanists, portrayers, facilitators, and regulators. The humanists reflected the view that professional values include respect for human dignity, personal integrity, protection of patient privacy, and protection of patients from harm. The portrayers believed that professionalism is evidenced by one's image, attire, and expression. For facilitators, professionalism not only involves standards and policies but also includes personal beliefs and values. The regulators believed that professionalism is fostered by a workplace in which suitable beliefs and standards are communicated, accepted, and implemented by its staff. The differences indicate that there may be numerous contextual variables that affect individuals' perceptions of professionalism.

"Maintaining connections but wanting more": the continuity of familial relationships among assisted-living residents.

Social support is a key component of well-being for older adults, particularly for those who have moved from independent living to assisted living involving a transformation of roles, relationships, and responsibilities. Twenty-nine assisted-living facility residents were interviewed to understand the perceived continuity of relationships with family and friends. An inductive approach to thematic analysis revealed 1 main theme and 3 subthemes. The main theme that emerged was: maintaining connections but wanting more. Residents appreciated maintaining connections with family and friends, but often expressed feelings of discontentment with the continuity of former relationships. The subthemes included: appreciating family and friends, waiting for more, and losing control. Implications for research and practice are discussed.

A case study of professional change: the impact of the National Gerontological Social Work Competencies Survey.

Our society is aging, and this demographic change necessitates that all social workers have basic competency in gerontology. This article describes the results of a competency survey conducted in 2000, and how these results helped transform basic social work curricula and enhance gerontology-related resources. Results were used to encourage and assist social work faculty to infuse gerontological content into social work curriculum, which helped practitioners to gain the necessary knowledge and skills to meet the needs of a growing aging population. This social work education framework can be replicated in an effort to infuse gerontology content throughout other disciplines.

How can Rorty help nursing science in the development of a philosophical 'foundation'?

What can nurse scientists learn from Rorty in the development of a philosophical foundation? Indeed, Rorty in his 1989 text entitled Contingency, Irony, and Solidarity tantalizes the reader with debates of reason 'against' philosophizing. Forget truth seeking; move on to what matters. Rorty would rather the 'high brow' thinking go to those that do the work in order to make the effort useful. Nursing as an applied science, has something real that is worth looking at, and that nurse researchers need to think about. And as a profession built upon relationships, we should be thinking of the exchanges we have with those around us, of the contrasts in vocabularies used and of the contingencies involved, letting this launch us into our imaginings and areas of enquiry. The business of nurse researchers is to study what nurses do--how we care; Rorty would have us care. But, not to dismiss the reflective thinker as Rorty advocates for the self-doubting ironist to continue to seek the final vocabulary, the ideal of what 'this' means, accepting this as the best to be offered at the time. As a science struggling to find foundation, we need only to look at what we do and value--as antifoundational as Rorty portrays himself, Rorty 'ironically' may have revealed a foundation for nursing science that is consistent with its path.

Older adults with Alzheimer's disease in a faith community.

In the first phase of this study, focus groups were conducted with 12 clergy to explore how to meet the needs of Alzheimer's disease patients and their families. The clergy reported that although they do reach out to these families, they have not received formal training, so they often do not know what families need. Members of their congregations who are trained in working with Alzheimer's patients need to partner with the clergy in reaching out to these families. Although this article mainly focuses on the clergy's perspective, in the second phase of the study, caregivers and early-stage Alzheimer's patients were asked to describe their experiences of spiritual connections related to Alzheimer's disease.

Collaborating, teaching and learning in a cyberspace community: a virtual AGE experience.

This paper describes one outcome of a collaborative teaching and learning partnership between two Universities via a Web-based environment. A description and evaluation of a semester-long project combining students from two different universities is examined. A total of 22 students participated as members of six different virtual health-care teams. Each team was charged with (1) creating a team contract; (2) completing an electronic patient medical record; and (3) a patient care plan. Students posted to discussion threads regularly using learning objects developed by faculty for Virtual AGE (vAGE-Active Gerontology Education). The successes and lessons learned for both students and faculty are discussed.

Who will care for the grandparents? Exploring relationships between grandparents and grandchildren.

Adult children are often identified as primary caregivers for their older adult parents; however, in a growing number of cases, the adult child does not become the caregiver. Evidence of this includes the growing social phenomenon of grandparents raising their grandchildren. In this qualitative research project, the long-term caregiving relationship between grandparents and grandchildren living in grandparent-headed households was explored through interviews with three grandparent-grandchild dyads. The ongoing relationship in the dyads did not seem to mimic a parent-child relationship or a grandparent-grandchild relationship, but instead a third kind of relationship that requires further exploration.

Keeping close: mothering with serious mental illness.

AIM: The aim of this paper is to describe the experiences of mothers with serious mental illness from their perspectives and how they attempted to manage their mothering circumstances. BACKGROUND: The desire to mother in women with serious mental illness is increasingly acknowledged by healthcare professionals. For these women, mothering is often framed as a pathological problem needing professional intervention. Yet little is known about mothering and illness from the perspectives of the mothers themselves. METHOD: Using Glaser's grounded theory approach and both purposive and theoretical sampling, interviews were conducted with 20 mothers who were receiving treatment for mental health problems. The data were collected in 2002. FINDINGS: We found the core category of Keeping close described mothers' efforts to have meaningful relationships with their children in the context of illness and suffering. To this end, mothers chose strategies that would hide illness for the sake of protecting their roles and their children. These strategies--masking, censoring speech, doing motherwork and seeking help--served to imitate ideal perceptions of mothering while making illness invisible to their children. Mothering in illness, however, became a vortex of contradictions, resulting in mothers 'hitting bottom', a point in time when they realized they could not keep close via pretences. To return to the valued place of mother, they sought treatment, hoping to learn how to be with their children authentically. CONCLUSION: To assist mothers with serious mental illness, healthcare professionals must be sensitive to the social and cultural context in which they mother in order to create healthier possibilities for nurturing their children.