Sleep quality assessment of adults in care settings using non-wearable sleep trackers: Scoping review.

AIMS: This review aimed to explore and map the literature on sleep quality assessments of adults in care settings using non-wearable sleep trackers. BACKGROUND: Sleep-monitoring technology is advancing, and sleep quality assessments using non-wearable sleep trackers can provide objective evidence for quality care. DESIGN: This was a scoping review. DATA SOURCES: Four electronic databases (PubMed, CINAHL, PsycInfo and Embase) were searched on 23 September 2022. REVIEW METHODS: This review followed the Joanna Briggs Institute's methodology and used the PRISMA-ScR checklist. RESULTS: Thirty studies met our inclusion criteria. Sleep quality was assessed at home and in acute, non-acute and long-term care facilities. Physiological (heart rate and respiratory rate) and sleep parameters were assessed alone or in combination during patient care using non-wearable sleep trackers. Sleep parameters representing sleep quality varied across studies. Real-time monitoring with non-wearable sleep-tracking devices effectively shortened the length of hospital stay. However, studies investigating caregivers and nursing outcomes are lacking in the literature. CONCLUSION: Sleep quality assessments using non-wearable sleep trackers may facilitate the provision of quality care in home-based and clinical care settings. Future studies should focus on caregivers and care outcomes that could contribute to evidence-based nursing practice for sleep care in adults.

Barriers to Advance Care Planning in Older Adults With Dementia, Their Families and Healthcare Professionals: An Umbrella Review of Qualitative Evidence.

This umbrella review aimed to examine and synthesize qualitative studies that explored the barriers and facilitators of advance care planning for persons with dementia, their families, and their healthcare professionals and caregivers. The modified umbrella review approach developed by the Joanna Briggs Institute was followed. Five major English databases were searched. Four reviews based on 38 primary qualitative studies were included. The methodological quality of the included reviews was moderate to high. The synthesis yielded 16 descriptive themes and five analytical themes: making the wishes/preferences of persons with dementia visible; constructive collaboration based on stakeholders having positive relationships; emotional chaos in facing end-of-life substitute decision-making; initiating the advance care planning process; and preparedness and commitment of healthcare providers to advance care planning. Comprehensive and workable strategies are required to overcome complex and interrelated barriers involving not only healthcare professionals but also organizational and systemic challenges.

Assisted bathing of older adults with dementia: a mixed methods systematic review update.

OBJECTIVE: This review update aimed to determine the best strategies for assisted bathing or showering for older adults with dementia. INTRODUCTION: Assisted bathing is a high-risk activity, as it can trigger agitated behaviors. Assisted bathing of older adults with dementia can create caregiver challenges and stress. INCLUSION CRITERIA: This review update considered quantitative, qualitative, and mixed methods studies that investigated, firstly, older adults with dementia who required assistance with bathing and, secondly, their caregivers and family members who provided this assistance. The quantitative component considered randomized controlled trials and quasi-experimental studies testing interventions for reducing agitated behaviors in older adults with dementia during bathing, as well as perceived confidence or satisfaction in caregivers. The qualitative component considered studies that reported on experiences of clients or caregivers during the bathing process. METHODS: A JBI mixed methods review was conducted following the convergent segregated approach. The review considered studies published between 1990 and March 11, 2022. The databases searched were PubMed, CINAHL, and Embase. Gray literature was also searched. Two independent reviewers screened titles and abstracts. Full texts were retrieved for studies that met the inclusion criteria and were assessed further for eligibility. Two reviewers independently assessed the quality of included studies and extracted data using the standardized JBI tools. Due to methodological and clinical heterogeneity, the results were presented narratively in the quantitative section. For the qualitative component, meta-synthesis was conducted following the JBI approach of meta-aggregation. Finally, evidence from the 2 components was integrated following the convergent segregated approach. RESULTS: Ten quantitative and 4 qualitative studies were included. The methodological quality was poor to moderate in the quantitative studies and moderate to high in the qualitative studies. Results from 3 quantitative studies suggested that providing training to caregivers on person-centered bathing reduced agitated behaviors in older adults with dementia. Other interventions did not show conclusive evidence of their effectiveness in any outcomes of interest. Two synthesized findings highlighted i) the importance of working within each person's reality by having the skills and knowledge required to deliver person-centered assistance and ii) the challenges experienced by caregivers, such as lack of support, time pressure, and safety-related fears. The integrated evidence showed that the quantitative and qualitative components complemented each other to promote the training of caregivers to deliver person-centered bathing. DISCUSSION: Integrated findings can help inform an evidence-based strategy utilizing a person-centered bathing approach to reduce agitated behaviors in older adults with dementia. Due to the limited number of eligible studies, and the clinical and methodological heterogeneity of included quantitative studies, no statistical pooling was possible. More studies are needed, particularly intervention studies with high methodological quality. CONCLUSIONS: This review update suggests that providing caregivers with person-centered bathing training should be encouraged prior to bathing older adults with dementia. Caregivers should have the knowledge and skills, such as relevant assessment and communication skills, enabling them to provide effective bathing experiences to older adults living with dementia. Organizations should provide caregivers with appropriate resources and training for bathing older adults with dementia. REVIEW REGISTRATION: PROSPERO CRD42020208048. SUPPLEMENTAL DIGITAL CONTENT: A Japanese-language version of the abstract of this review is available as supplemental digital content 1: http://links.lww.com/SRX/A37 .

Incidence of severe infection in patients with rheumatoid arthritis taking biologic agents: a systematic review.

OBJECTIVE: The objective of this review was to estimate the population-based incidence and determine the types of severe infection and deaths experienced by patients with rheumatoid arthritis taking biologic agents. INTRODUCTION: Since the late 1990s, various biologic and synthetic drugs have been developed to treat rheumatoid arthritis. In recent years, the incidence of severe infection in patients with rheumatoid arthritis in Western nations has been determined by observational studies; however, no systematic review has been conducted on this topic. INCLUSION CRITERIA: The following inclusion criteria were considered: i) observational studies on patients with rheumatoid arthritis treated with biologic agents; ii) studies reporting the number of severe infections requiring hospitalization for treatment; iii) studies reporting person-years of observation data; and iv) studies based on rheumatoid arthritis registries, medical records from rheumatology centers, or insurance claim databases. METHODS: PubMed, CINAHL, Embase, and Web of Science were searched to identify published studies. The reference lists of all studies selected for critical appraisal were screened for additional studies. Unpublished studies were searched on MedNar and OpenGrey databases. All the searches were updated on December 6, 2021. After removing the duplicates, 2 independent reviewers screened titles and abstracts against the inclusion criteria and then assessed full texts against the criteria. Two reviewers independently appraised the study and outcome levels for methodological quality using the critical appraisal instrument for cohort studies from JBI. Two reviewers extracted the relevant information related to severe infection and drugs. RESULTS: Fifty-two studies from 21 countries reported severe infection rates associated with using 8 biologic agents, plus nonbiologic disease-modifying antirheumatic drugs. In total, 18,428 infections with 395,065 person-years of biologic drug exposure were included in the analysis. Thirty-five studies included infections in outpatients receiving intravenous antibiotic therapy. Fifteen studies reported the first episode of infection, and the remaining studies did not specify either the first or all of the episodes of infection. Inclusion of viral infection and/or opportunistic infection varied among studies. Fifteen studies reported the site of infection; respiratory, skin/soft tissue, urinary tract, and sepsis/bacteremia were commonly reported. Ten studies reported the case fatality rates, ranging from 2.5% to 22.2%. Meta-analysis was conducted for 8 biologic agents and conventional disease-modifying antirheumatic drugs. The infection rate varied from 0.9 to 18.1/100 person-years. The meta-analysis revealed an infection rate of 5.0/100 person-years (95% CI 3.8-6.7) among patients receiving tumor necrosis factor inhibitors (heterogeneity 98.2%). The meta-analysis for the other 3 biologic agents revealed a point estimate of 5.5 to 8.7/100 person-years with high heterogeneity. Sensitivity analysis indicated that registry-based studies were less likely to have very low or very high infection rates compared with other data sources. The definition of infection, the patient composition of the cohorts, and the type of databases appeared to be the primary sources of clinical and methodological heterogeneity. CONCLUSIONS: Due to high statistical heterogeneity, the meta-analysis was not suited to estimating a summary measure of the infection rate. Developing standardized data collection is necessary to compare infection rates across studies. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020175137.

Experiences of families of people living with frontotemporal dementia: a qualitative systematic review.

Frontotemporal dementia (FTD) is characterised by atrophy of the frontal and/or temporal lobes. People with FTD show language and emotional disturbances from onset, and communication problems usually affect people with FTD and their families even before diagnosis. These unique characteristics of FTD are not well understood and create substantial problems for people living with FTD and their families. This review explores the experiences of families of people living with FTD. Studies were selected and screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched four bibliographic databases for articles up to February 2021 to identify qualitative data on the experiences of families. The Critical Appraisal Skills Programme checklist for qualitative studies was used to assess all included studies. Of 235 identified articles, we included six studies in the qualitative synthesis. Meta-ethnography was conducted to interpret families' experiences of people living with FTD. The emergent concepts were synthesised into five themes: Something is wrong with my loved one; No one fully understands; Existential pain of caring for a loved one with FTD; Increased burden owing to specific FTD symptoms; and Forced to adapt to new and unique ways of living with a loved one with FTD. This review highlighted families' confusion and suffering (which began in the early stages of the disease, and sometimes before diagnosis) and the difficulty of communicating with people with FTD. These findings have implications for future practice, as they demonstrate the positive effect on family life of appropriate support that is provided early, rather than after the disease has progressed.

Severe infection risk in patients treated with biologics for rheumatoid arthritis: a systematic review protocol.

OBJECTIVE: The objective of this review is to estimate the population-based incidence and to determine the types of severe infection experienced by patients with rheumatoid arthritis who are taking biological agents. INTRODUCTION: Since the late 1990s, a variety of biological and synthetic drugs have been developed to treat rheumatoid arthritis. In recent years, the incidence of severe infection in patients with rheumatoid arthritis in Western nations has been reported by observational studies; however, no systematic review has been conducted on this topic. INCLUSION CRITERIA: The following criteria will be considered for inclusion: i) observational studies on patients with rheumatoid arthritis who are taking biological agents; ii) studies reporting the number of severe infections requiring hospitalization for treatment; and iii) studies with person-years of observational data. METHODS: MEDLINE, CINAHL, Embase, and Web of Science will be searched to identify published studies. The reference lists of all studies that are selected for critical appraisal will be screened for additional studies. The search for unpublished studies will include MedNar and OpenGrey. Only studies published in English from 1999 to the present will be included. Screening of studies, assessment of methodological quality, and data extraction will be performed by two independent reviewers. If possible, studies will be pooled in statistical meta-analysis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020175137.

Components of Empowerment Among Family Caregivers of Community-Dwelling People With Dementia in Japan: A Qualitative Research Study.

BACKGROUND: Family caregivers of people with dementia (PWDs) experience significant physical, psychological, and social burdens. Empowerment, which refers to the process of gaining power in society through behavioral change, is important to coping successfully with care-related burdens. The high burden of care faced by family caregivers in Japan often makes accepting social support difficult for caregivers of PWDs, resulting in feelings of isolation. Clarifying what components constitute empowering experiences for family caregivers of PWDs is necessary to gain a better understanding of their empowerment experiences and to develop relevant support schemes. PURPOSE: This study was developed to describe the components of empowerment experienced by family caregivers of community-dwelling PWDs in Japan. METHODS: This qualitative descriptive study used semistructured in-depth interviews to explore components of empowerment experienced by family caregivers of adults/older adults with dementia. Purposive sampling was used to recruit 20 family caregivers (age range: 50-87 years) from four self-help groups. A qualitative content analysis method was used to analyze the data. The components derived from the interviews were reviewed by three nursing researchers not directly involved in this study who are specialists in qualitative research and geriatric nursing. RESULTS: Four categories and 12 subcategories were derived to illuminate the components of empowerment among family caregivers of PWDs. Specifically, these categories were as follows: (a) proactive aspects of dementia care that were acquired through the caregiving experience, (b) creating a relationship that respects PWDs, (c) Building relationships based on mutual understanding of one's surroundings, and (d) understanding the social aspects of dementia care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study provide additional understanding of the components of the empowerment experiences of family caregivers of PWDs in Japan and in other East Asian countries experiencing increasing dementia diagnoses and population aging. In addition, the structural components of empowerment offer a useful perspective for health professionals on assessment and intervention that is framed on the cultural characteristics of East Asia. Ultimately, the results suggest that healthcare professionals should develop intervention programs that are tailored to the needs of caregivers at different levels of empowerment.

Assisted bathing of older people with dementia: a mixed methods systematic review protocol.

OBJECTIVE: The objective of this review update is to determine the best strategies for assisted bathing or showering of older people with dementia. INTRODUCTION: Bathing is a high-risk activity that can worsen agitated behavior in people with dementia, becoming a source of stress or burden for nurses and caregivers. Since a review was originally published in 2013, new studies have been conducted reporting on various interventions related to assisted bathing and showering. INCLUSION CRITERIA: The review will consider people older than 60 years with dementia, their families, nurses, and formal caregivers. The quantitative component will consider studies that examine interventions aiming to reduce agitated behaviors during assisted bathing. The qualitative component will include studies reporting on experiences of assisted bathing of older people with dementia. METHODS: This review update will follow the JBI mixed methods review approach. Published and unpublished studies will be identified from searches of the major international databases and relevant databases for gray literature. Two independent reviewers will carry out screening, critical appraisal, and data extraction. The extracted data will include details about the study characteristics, quantitative results, and qualitative findings relevant to the review. Where possible, quantitative data will be statistically pooled. Qualitative results will be synthesized using the meta-aggregation approach developed by JBI. Finally, the findings from both quantitative and qualitative components will be organized into a line of argument to produce an overall configured analysis. Where configuration is not possible, the findings will be presented in narrative form. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020208048.

Best evidence for advance care planning in older adults with dementia and their families: an umbrella review protocol.

OBJECTIVE: The objective of this review is to summarize current best evidence for advance care planning in older adults with dementia and their families. INTRODUCTION: Contemporary end-of-life care cannot be fully achieved without high quality advance care planning practice, which facilitates the expression of patient preferences for treatment if they lose the capacity to decide or communicate their wishes. However, advance care planning for people experiencing dementia can be highly complex and requires additional knowledge and skills. Improving advance care planning for this vulnerable patient group is an urgent matter. INCLUSION CRITERIA: The review will include systematic reviews of quantitative, qualitative, and mixed-method studies examining advance care planning for older adults with dementia and their families, published from 2000. METHODS: Published and unpublished reviews will be identified from searches of the major international databases and relevant databases for gray literature, respectively. Two independent reviewers will conduct screening, critical appraisal, and data extraction for included studies. The extracted data will include specific details about the study characteristics (e.g. setting/context, participants, and the intervention/phenomena of interest), quantitative results (including heterogeneity), and qualitative findings relevant to the review. Results of systematic reviews will be presented in tabular format and accompanied by narrative synthesis. Qualitative results will include the overall synthesis of findings. Overlap of original research studies of any design across multiple systematic reviews will be clearly identified.

Nurses' experience in providing care at shelters following natural hazards and disasters: a qualitative systematic review protocol.

OBJECTIVE: The review will synthesize current evidence regarding the experiences of nurses who care for people living in shelters following natural hazards and disasters. INTRODUCTION: Over the last decade, due to climate change and global warming, the damage caused by natural hazards and disasters like hurricanes, floods and heavy rainfall has been steadily growing. Following natural hazards and disasters, many who lose their homes reside in evacuation shelters for prolonged periods. The loss of medical infrastructure in disaster-stricken areas can result in evacuees' health being compromised and the spread of disease and/or infection. Under such circumstances, disaster relief nurses can play a critical role in supporting these victims. This review aims to provide useful information for nurses who are working in disaster shelters. INCLUSION CRITERIA: The review will include qualitative studies examining experiences of nurses caring for people living in shelters following natural hazards and disasters, published in either English or Japanese. Studies published from 2000 to the present will be considered. METHODS: The review will follow the meta-aggregation approach developed by JBI. Published and unpublished studies will be searched using major international databases and other relevant databases for gray literature in either English or Japanese. Two reviewers will independently appraise studies and extract qualitative data using the JBI standardized critical appraisal and extraction instruments. Findings from the review will be categorized according to their similarity in meaning and their categories subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings. The final synthesized findings will be graded according to the ConQual approach.

Review and synthesis of the experience of patients following total hip or knee arthroplasty in the era of rapidly decreasing hospital length of stay.

AIM: The hospital length of stay for orthopedic surgery has been decreasing during the last couple of decades. Therefore, this study was performed to explore the postoperative experiences of adult/older patients (age ≥20 years) with osteoarthritis who underwent total hip or knee arthroplasty, focusing on the first 6 weeks following discharge. METHODS: A systematic literature search on qualitative studies was conducted using six databases, such as Medline, CINAHL and Mednar. Verbatim interview data and themes or subthemes related to the patients' experience after discharge were extracted. Content analysis was used to code interview data. Codes similar in meaning were grouped, and subcategories were formed. These subcategories were then grouped into categories. RESULTS: Sixteen qualitative studies with 253 participants were analyzed. In total, 136 codes were generated and formed 29 subcategories. Six categories were generated: (a) postoperative pain and medication; (b) difficulty in performing activities of daily living; (c) appreciation for support and difficulties associated with receiving support; (d) variability in recovery process and information-seeking; (e) lack of patient-centered care; and (f) transportation problems and social isolation. CONCLUSION: Our review suggests that prospective patients and their caregivers need individually tailored presurgical education and advanced planning for postsurgical reduced mobility.

End-of-life nursing care practice in long-term care settings for older adults: A qualitative systematic review.

AIM: To synthesize qualitative evidence on nurses' end-of-life care practices in long-term care settings for older adults. BACKGROUND: Qualitative evidence on how nurses describe their own end-of-life care practice has not been reviewed systematically. DESIGN: Qualitative systematic review. DATA SOURCES: Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese. METHODS: The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta-aggregation. RESULTS: Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork. CONCLUSION: Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end-of-life care that ensures residents die with dignity.

Review of outcome measures in PARO robot intervention studies for dementia care.

The aim of this study was to describe interventions for PARO, as well as the outcomes evaluated and found following use of PARO, and to identify outcome measures in PARO intervention studies for older adults with dementia. Multiple databases (Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Cochrane, and Scopus) were searched and eight studies were included in the systematic review. The review demonstrated that interventions using PARO can be beneficial for improving QOL, affect, social interaction, and reducing NPS and psychotropic or pain medication use. This study identified three domains of outcome measures used to assess the effects of interventions using the PARO robot: quality of life, biological and physiological conditions, and medical treatment.

Experience of patients following lower limb joint replacement: a systematic review protocol.

REVIEW QUESTION: The objective of this proposed review is to explore the postoperative experiences of adult patients who have undergone lower limb joint replacement. Specifically, the review question is: What are the postoperative experiences during the six-week post-discharge period of adult patients who have undergone lower limb joint replacement?

An integrated literature review on sexuality of elderly nursing home residents with dementia.

This study presents an integrative literature review on sexuality among elderly people with dementia living in nursing homes. Original research studies published from 1980 to 2012 were included in the review. Sexual expressions ranged from holding hands to sexual intercourse. These behaviours were sometimes directed towards caregivers while the latter were providing daily care. Sexual expressions were sometimes assessed and reported subjectively without context. Responses to sexual expressions varied from positive to negative. Some sexual expressions were dealt with inconsistently, and some were considered to be problematic due to a lack of policy or privacy. It is important to assess and report sexual expressions objectively, preferably with a standardized form, and to consider context in doing so. Effort is required to provide privacy for residents' sexual expressions and a safe environment for all residents and caregivers. It is important that a policy and guidelines for care be established regarding issues related to sexuality among elderly people with dementia.

A best-evidence review of intervention studies for minimizing resistance-to-care behaviours for older adults with dementia in nursing homes.

AIM: To conduct a best-evidence review of non-pharmacological interventions for resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. BACKGROUND: Resistance to care is a major source of staff burnout in nursing homes and it is also a safety issue for the staff. DESIGN: Best-evidence review. DATA SOURCES: We searched for non-pharmacological intervention studies published from 1990-2012, written in English. REVIEW METHODS: The search identified 19 intervention studies that examined the effects of interventions to reduce the resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. These 19 papers met the quality assessment requirements of the critical appraisal criteria for experimental studies, which were published by the Joanna Briggs Institute. RESULTS: Only three studies were RCTs and the rest were quasi-experimental. The sample size ranged from 7-127. Nine music interventions, such as pre-recorded music played to a group or playing a resident's preferred music, during his or her personal care, resulted in significant reductions in resistance-to-care behaviours. Resistance-to-care behaviours also were significantly reduced in three of four bathing interventions that focused on person-centred care. In the ability-focused interventions, only two out of five studies reported significant reductions in resistance-to-care behaviours. CONCLUSION: Non-pharmacological interventions are options to consider to reduce resistance-to-care behaviours in older people with dementia, even though the evidence level is low, given the lack of alternatives. More randomized controlled trials are recommended to confirm the effects of non-pharmacological interventions during personal care.

The best evidence for minimizing resistance-to-care during assisted personal care for older adults with dementia in nursing homes: a systematic review.

OBJECTIVE: To determine the effectiveness of interventions in minimizing resistance-to-care behaviors during assisted personal care for nursing home residents with dementia. REVIEW QUESTIONS: • What interventions are effective for reducing the frequency and intensity of resistance-to-care behaviors during assisted personal care activities (i.e. mealtime assistance, toileting, mouth care, morning care and shower/bathing) for nursing home residents with dementia?• What interventions are effective for reducing the frequency and intensity of resistance-to-care behaviors for overall daily personal care activities for nursing home residents with dementia? BACKGROUND: In many countries the proportion of older adults with dementia is steadily increasing. Many older adults with dementia live in nursing homes and most of them require assistance with personal care due to having dementia-related symptoms. Nursing staff and formal caregivers frequently experience resistance or rejection from such residents when they are providing care. Such behavior can be a large obstacle, particularly when caregivers attempt to provide assistance in daily personal care including oral care, bathing, feeding, dressing and toileting.The definition of "resistance-to-care" means physically and/or psychologically resistive behavior, for example "pulling away from staff, tightening limbs, stiffening the body, deliberately ceasing or refusing to weight bear during care, waving arms and legs and verbally objecting to care using words and/or sounds" (p.7). Several other definitions can be found in the literature concerning the resistance-to-care behaviors exhibited by nursing home residents with dementia. No distinct difference seems to exist for what terms mean and they are often used interchangeably in the studies on nursing. For instance, Mahoney et al. have defined the term "resistive to care" to mean "the repertoire of behaviors with which persons with dementia withstand or oppose the efforts of a caregiver" (p.28). Other commonly used terms include "rejection of care", "resistant behaviour", "resistivenessto care (RTC)", "care-resistant behavior (CRB)", and "resistance to care". In this review the term "resistance-to-care" will be used to retain consistency of meaning.Resistance-to-care behaviors are commonly reported phenomena in the aged care field. One US study reported 9% of 23,837 nursing home residents experiencing dementia demonstrated resistance-to-care behaviors and another US study also reported a similar percentage, i.e. 9.7% of 3,230 residents. From the caregivers' perspective experiences of confronting these care resistant behaviors have been well documented. A study conducted in Sweden showed 79% of 86 nursing home staff in Stockholm, Sweden reported being rejected by the residents and 96.9% of 494 nurses in 11 Norwegian nursing homes reported that they experienced resistant behavior from the residents during personal care. Resistance-to-care behaviors can cause serious problems for both caregivers and dementia-stricken residents. Caregivers experience enormous physical and emotional distress from such behaviors carried out by their residents. Resistance-to-care behaviors can cause physical and psychological injury to caregivers. For the residents such behaviors can lead to malnutrition, skin breakdown, dehydration, constipation, weight loss and other health problems. Furthermore, inability to manage resistance-to-care behaviors may cause verbal and non-verbal abusive behaviors and physical and psychological harms to caregivers. This in turn may result in residents being inappropriately physically and/or medically restrained. Therefore, effective prevention and management of such behaviors is crucial for both care providers and nursing home residents with dementia.Several systematic literature reviews have been published on the nature and management of dementia-related behaviors. Those reviews addressed topics including hygiene care in residential aged care facilities, aggressive behavior toward caregivers, therapeutic effects of music and singing, the use of preferred music intervention at mealtimes, feeding-related nursing care, and a review on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty. A recently published review has reported on the relevant factors that trigger resistance-to-care behaviors.By examining previously published systematic reviews, it was evident that their focus tended to be broad and not solely concerned with resistance-to-care behaviors in the context of daily personal care. Alternatively, they addressed a specific care situation such as oral care or mealtime, raising questions whether interventions should differ for each care activity or if any interventions can be effective in daily personal care in general. Thus, the present review will aim to examine what interventions are effective for managing or reducing resistance-to-care behaviors of nursing home residents who have dementia. The review will focus on effective interventions for each care activity in daily personal care and overall daily personal care. Thus the review's results will provide practical recommendations concerning the effective nursing care for each daily care activity and overall daily care activities for managing resistance-to-care behaviors of older adults with dementia in nursing homes.Resistance-to-care behaviors are, in reality, often very difficult to differentiate from other dementia-related behaviors. For instance the term "noncompliance" was used in one study referring to "resistiveness to care", which preceded physically aggressive behavior occurring in response to the invasion of the resident's personal space. This clearly encapsulates the resistive nature of the behavior demonstrated by nursing home residents. Other terms possibly overlapping with the meaning of "resistance-to-care" behaviors include "uncooperative behaviours", "disruptive behaviours", "aggression/aggressive behaviours", "combative behaviour", or "agitation/ agitated behaviours". Again, these terms are largely used interchangeably and no clear cut difference appears to exist in the nursing literature. For this reason the review will include any papers that have used any of those definitions as long as the studies meet the inclusion criteria.A preliminary search of the JBI Library of systematic reviews, PubMed, CINAHL and the Cochrane library have shown there is no systematic review on the present topic.

The effects of Canine-Assisted Interventions (CAIs) on the health and social care of older people residing in long term care: a systematic review.

EXECUTIVE SUMMARY: Background: Animal-assisted interventions are classified as 'any therapeutic process that intentionally includes or involves animals as part of the process'. Providing these interventions within the long term care environment may potentially reduce or alleviate symptoms of disease and illness and increase quality of life. Many people suggest that the use of animal-assisted interventions produces beneficial effects, however an examination of the current evidence base reveals a lack of rigorous quantitative research in this area.Objective The aim of the review was to synthesise the best available evidence on the effects of canine-assisted interventions on the health and social care of the older population residing in long-term care.Data sources A comprehensive search was undertaken on 32 electronic databases from their inception to 2009. The search was restricted to English language and both published and unpublished studies were considered.Review methods Studies that examined canine-assisted interventions used for older people residing in long term care were considered. Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments. Data extraction was via the Joanna Briggs Institute standard data extraction form for evidence of effectiveness.Results Eight randomised controlled trials were included in the review of which half were doctoral theses. Due to the presence of heterogeneity, meta-analyses were not appropriate and a narrative summary was provided.Based on the results of single studies, the evidence suggests that providing canine-assisted interventions in long term care facilities can provide some short term benefits to residents, both physically and emotionally, however they appear to be no more effective than other interventions such as visits from humans and providing opportunities to interact with inanimate objects. Providing sessions once a week seems to be just as effective as providing session three times a week in the short term and more research is needed to determine if providing interventions on an individual basis is actually more effective than group interactionsConclusion The current evidence base for the effects of canine-assisted interventions in long term care facilities is methodologically weak and is unable to be pooled. No solid recommendations can be made, however some preliminary conclusions based on the results of single studies are provided. Caution is advised when interpreting these results.Implications for practice Due to the poor quality of evidence located on this topic the use of canine-assisted interventions cannot currently be recommended nor refuted. If, however, a long term care facility is considering implementing canine-assisted interventions for older residents they should be aware that canine-assisted activities may produce some short term beneficial effects but they are similar to those seen from organising visits from people or arranging interactions with animal-like inanimate objects.Implications for research Due to the lack of well-designed trials further higher quality experimental studies that examine the effects of canine-assisted interventions on older long term care residents should be conducted. Trials need to be conducted following a standardised rigorous process.