Evidence-Based Practice: Implementing REIS Findings in South African Aged Care Facilities.

BACKGROUND: Older adults living in Residential Aged Care Facilities (RACFs) in South Africa are often exposed to environments that fail to provide adequate occupational opportunities. Practitioners in developing economies are challenged to provide therapeutic services in environments that emphasize occupational deprivation. OBJECTIVES: This study investigated barriers and enablers to implementing recommendations derived from the findings generated by the Residential Environment Impact Scale (REIS). METHOD: A two-phased embedded mixed methodology was employed. Phase 1 was the administration of the REIS. In Phase 2, leadership staff considered factors to implementing findings of the REIS, using the nominal discussion group technique. Data were thematically analyzed. FINDINGS: Findings indicated an organizational culture characterized by top-down management and a medically dominated care approach, constrained by financial and operational concerns. CONCLUSION: Using the REIS to holistically assess, RACFs are an applicable tool that could promote collaborative approaches to enhance organizational culture change, cultivating more occupational opportunities.

Promoting meaningful engagement for residents living with dementia through intergenerational programs: a pilot study.

OBJECTIVES: Residents living with dementia in residential aged care facilities (RACFs) have reduced access to, and opportunities for, participation in meaningful activities. This leads to increased social isolation and disengagement. Intergenerational programs aim to overcome these issues. Allied health students piloted a live-intergenerational program (LIP), living onsite at a residential aged care facility (RACF) while volunteering for 30 h a month. The purpose of this study was to explore the impact and practicalities for implementing a LIP in an Australian RACF. METHODS: This qualitative descriptive pilot study was undertaken to explore the diverse perspectives of various stakeholders. Qualitative data were collected during group discussions directed by the nominal group technique with live-in-students. Interviews were conducted with staff members, relatives, facility management and volunteers. All qualitative data were analysed thematically. RESULTS: Two overarching themes emerged. The first, community of care, indicated how care partners and the care context, organisational support and being a live-in-student supported the sustainability of the program. Live-in-students' accessibility promoted opportunities for occupational and social engagement of residents when staff was less available. The second, a collective based on belonging and shared doing, highlighted the program's potential impact and uncovered the development of a collective based on shared belonging. CONCLUSION: The LIP highlighted the potential for new dimensions to person-centred care. The pilot study demonstrated intergenerational contact within aged residential care supported the evolvement of a collective and promoted a social approach for ageing well. Further research is needed to identify the long-term impact of the LIP and explore the feasibility of expanding the program.

Barriers and facilitators of meaningful engagement among older migrants living with dementia in residential aged care facilities: A mixed studies systematic review.

BACKGROUND: Migrants with dementia living in residential care may be at risk of disengagement. OBJECTIVE: To synthesize research relating to the meaningful engagement of migrants with dementia who are living in residential care. METHOD: Mixed studies systematic review following PRISMA guidelines. Nine electronic databases were searched for relevant studies. Studies were eligible for inclusion if they reported original research relating to meaningful engagement of migrants with dementia living in residential aged care and were published in English. Two independent reviewers screened the title and abstracts, full texts of eligible studies and conducted a quality appraisal of included texts. A convergent qualitative synthesis approach was used. RESULTS: From 1460 articles, 14 papers representing 12 studies were included. Facilitators of meaningful engagement included: the presence of cultural artefacts in the care environment, the use of multimodal communication and a shared but flexible understanding of residents' culture. Barriers were the absence of a common language and a task-orientated approach to care. CONCLUSIONS: Migrants with dementia who are living in residential care are at increased risk of disengagement. Our review highlights the need for culturally congruent residential care to go beyond issues of language and to consider how occupations can be tailored to support ongoing participation and engagement.

The residential environment impact scale: Benefits and barriers to implementation in the Australian residential aged care facility context.

The organisational, physical and social environment within residential aged care settings greatly influence its residents' sense of autonomy, choice and control and their ability to engage in meaningful occupations. Identifying to what extent these environmental contexts are supportive and well-coordinated could assist with promoting meaningful engagement of residents. The Residential Environment Impact Scale (REIS) was developed to measure the impact of the physical and social environment on residents. This study examined the benefits and barriers to implementing the REIS in four Australian Residential Aged Care Facilities (RACFs) and factors to consider during implementation. METHOD: A multisite sequential mixed-methods study was conducted. Research participants included occupational therapists conducting the REIS and leadership staff examining the REIS reports in four facilities. Data consisted of formal observations of the REIS assessment process, an online survey of all participants and two research consensus groups. Qualitative findings were generated from field notes, open-ended survey questions and group discussions. Close-ended survey questions provided quantitative data. FINDINGS: The REIS was considered a useful audit tool, generating a holistic overview of the RACF. It highlighted the quality of person-centred care and the potential role of occupational therapists to promote opportunities for meaningful occupational engagement. Barriers included administration time, personal characteristics of residents and limited resources to action recommendations. CONCLUSION: The REIS has potential to be an audit tool for a whole-environment approach to facility assessment of residents' sense of autonomy, occupational choice and meaningful engagement. As such, it provides occupational therapists with scope to support RACFs meeting national quality standards.

The use of technology to promote meaningful engagement for adults with dementia in residential aged care: a scoping review.

INTRODUCTION: A considerable number of adults with dementia live in residential aged care facilities, where loneliness and boredom are common. Computer-based and electronic technologies have advanced significantly and there is potential for such technologies to improve engagement of residents with dementia. However, the nature and extent of the evidence supporting the use of these technologies is unclear. OBJECTIVES: The aim of this study was to investigate the use of computer-based and electronic technologies for enhancing meaningful engagement of adults with dementia living in residential aged care. METHODS: A scoping review was conducted. Nine databases were searched from 2008-2018. Included studies were summarized, compared and synthesized according to technology type. RESULTS: Twenty studies were included. Most studies were conducted in Australia (n = 7) and Europe (n = 8). Study designs were quantitative (n = 12), mixed methods (n = 5), descriptive (n = 2) or qualitative (n = 1). Studies aimed to investigate interaction, engagement, behaviors or quality of life (n = 14), to examine the feasibility of technologies (n = 3), or had both aims (n = 3). Technology type fell into two categories: robotics (n = 14) and multi-media computer programs (n = 6). Across both technology types, there were conflicting results in relation to positive impact on meaningful engagement. Studies only investigated the doing, belonging and connecting aspects of meaningful engagement. Additionally, there was a lack of consistency across studies in how activity, interaction and engagement were measured. CONCLUSION: The role and potential of new technologies to enhance meaningful engagement for those with dementia should focus on creating human-to-human interactions while taking individual preference and person-centered principles into account.

Meaningful engagement and person-centered residential dementia care: A critical interpretive synthesis.

BACKGROUND: People with moderate to advanced dementia living in residential care are at risk of occupational deprivation. Person-centered care has been adopted as a guiding principle in the provision of residential care for older adults with dementia. In this context, there has been shift in occupational therapy practice from addressing occupational performance towards focusing on meaningful engagement. While both meaningful engagement and person-centered care have been well researched the relationship between the two concepts is poorly understood. AIM: A critical interpretative synthesis was conducted to determine how principles of person-centered care inform occupational therapy practice in relation to promotion of meaningful engagement among residents with moderate to advanced dementia. METHODS: A systematic search of research addressing meaningful engagement of people with moderate to advanced dementia identified 26 papers. RESULTS: Papers were classified as theoretical papers and empirical research. Two overarching constructs emerged, namely promoting a culture of collaborative care and understanding the resident as a person with a past, present and future. CONCLUSIONS: Occupational deprivation prevails and person-centered care is not fully addressed if opportunities for growth and engagement for residents with moderate to advanced dementia is not extended beyond their life history. SIGNIFICANCE: Creating continued opportunities for building agency of residents with dementia could promote occupational justice in residential care.

Embracing Cultural Diversity: Meaningful Engagement for Older Adults With Advanced Dementia in a Residential Care Setting.

Providing person-centered care (PCC) that focuses on meaningful engagement in residential care settings for older adults with moderate to advanced dementia is an internationally recognized challenge. In this study, we aimed to identify best-practice scenarios for supporting older adults with moderate to advanced dementia from culturally and linguistically diverse backgrounds who lived in care facilities. A mixed-methods study with a concurrent triangulation strategy was adopted. Data collection occurred with care partners by means of a preworkshop questionnaire, an appreciative-inquiry workshop, and an adapted Delphi technique. The findings indicate that care partners valued the care facilities' residents' needs for doing, being, and belonging. Collaborative data generation reflected the setting-specific PCC practices. Leadership team members agreed that enabling inclusion and celebrating cultural diversity were important but that cultural humility needed to be promoted.

Exploring service delivery in occupational therapy: The use of convergent interviewing.

BACKGROUND: Occupational therapy clinicians working in South Africa's public healthcare had views on what patients thought about their vocational rehabilitation services that were based on anecdotal evidence. However evidence-based practice requires more than that. Reliable information is important in patient-centred practice and in the assessment of service quality. OBJECTIVE: Clinical occupational therapists used the convergent interviewing technique to explore patients' views of the vocational rehabilitation services on offer in public hospitals. METHOD: An Action Learning Action Research (ALAR) approach was used to explore the vocational rehabilitation services occupational therapy clinicians provided over a two week period in three settings. RESULTS: The majority (96%) of patients interviewed were not aware that occupational therapists offered vocational rehabilitation services. The convergent interview technique allowed continued unrestricted discussion of their vocational rehabilitation concerns and provided evidence that patients had significant concerns about work. Critical reflection on the interview experience and technique indicated that therapists were in favour of using convergent interviewing to obtain their patients views about the services offered. Therapists found the convergent interview technique easy to apply in clinical practice. CONCLUSION: Establishing patients' views of a clinical service have multiple values. However it is meaningless unless clinicians use the knowledge to improve service delivery to the patients who provided the views. Convergent interviewing was a valuable technique for occupational therapy clinicians to incorporate patients' views of their services into service development.

Dignity and respect: facilitating meaningful occupation for SeSotho elders.

AIM: Frail and vulnerable adults are divested of meaningful encounters when modernization and urbanization force them to embrace an unconventional residential care environment as a home. The aim of this article is to report on a study of SeSotho elders living in residential care to illustrate how more meaningful and culturally relevant experiences could be facilitated for them. METHODS: A content analysis was done of the individual opinions of 15 collaborators as a secondary scrutiny of information obtained during a nominal group process. MAJOR FINDINGS. Findings revealed that elders were prone to experience loneliness, helplessness, and boredom due to situations dominated by occupational injustice. Co-occupations, training of staff, and environmental adaptations that allow a sense of interdependence could contribute in facilitating occupational justice for elders from a traditional South African indigenous background living in residential care. PRINCIPAL CONCLUSION: Human dignity and respect are upheld within residential care when elders have access to purposeful and meaningful activities of their choice that are culturally appropriate. Occupational therapists should advocate for doing, belonging, and becoming by facilitating meaningful occupational participation that is culturally relevant for their clients.