A feasible method to enhance and maintain the health of elderly living in long-term care facilities through long-term, simplified tai chi exercises

Practicing Tai Chi offers the potential to enhance the physical and mental health of older adults. Identifying a feasible way to encourage regular Tai Chi practice is essential if Tai Chi is to be promoted as a long-term, daily activity for elderly care facility residents. The purpose of this study was to test the effectiveness and feasibility of using an audiovisual, simplified Tai Chi exercise module to enhance and maintain the health of long-term care facility residents. A quasi-experimental, one-group, time-series design was used. Data were collected six times (twice before the intervention; four times after intervention started) at three-month intervals. Fifty-one elderly male subjects were recruited by convenience sampling. A 50-minute Simplified Tai-Chi Exercise Program (STEP) was implemented in two small groups three times a week for 12 months. During the first six-month period, participants received guidance from an actual instructor. During the second six-month period, guidance was delivered via a video tape and displayed on a television screen. Results indicated that participants' physical health (cardio-respiratory function, lower body flexibility, and hand-gripping strength) and mental health (quality of sleep) had both improved significantly six months after intervention started, with improvements maintained throughout the end of the 12-month study (all p values < .05). Instructor-led STEP training followed by practice using appropriate audiovisual aids represents a feasible and effective method to implement a long-term activity program in long-term elderly care facilities.     

Effects of a Relationship-Enhancing Program of Care on Outcomes

Purpose: To examine the effects of a relationship-enhancing program of care (REPC) on resident and care provider outcomes.
Design and Methods: A quasi-experimental, repeated measures design, with intervention and comparison groups. Questionnaires were distributed to 50 residents, and observations were conducted of 40 residents and 34 nursing staff at baseline and 3 months after the intervention, on two Canadian nursing home units. An investigator-designed educational program based on Winnicott's theory of relationships and the empirical literature, was provided to care providers and their supervisors on the intervention unit. Repeated measures analysis of variance (RM-ANOVA) was used to compare the intervention and comparison groups in regard to changes in the outcomes over time.
Findings: The REPC had statistically significant effects on (a) residents' perceptions of care providers' relational care, (b) care providers' relational behaviors, and (c) continuity of care.
Conclusions: Evidence showed that these care providers were taught how to enhance their relational skills with residents living in long-term care facilities without added staff. Recommendations for practice and research are discussed.     

Psycho-social factors affecting elders' maltreatment in long-term care facilities

Natan M.B., Lowenstein A. & Eisikovits Z. (2010) Psycho-social Factors Affecting Elders' Maltreatment in Long-term Care Facilities. International Nursing Review 57 , 113–120
Aim:  To examine and analyse major variables affecting maltreatment of elderly nursing home residents. The study was based on two theoretical paradigms: the theoretical model for predicting causes of maltreatment of elderly residents developed by Pillemer, and the Theory of Reasoned Action developed by Ajzen & Fishbein.
Methods:  The study employed a correlational quantitative method. The research population consisted of the staff of 22 nursing homes in Israel. Six hundred questionnaires were distributed in these facilities and 510 were completed and returned (85%). In addition, 24 questionnaires were distributed among directors of the facilities and 22 were returned (91.6%).
Findings:  Slightly more than half of the staff sampled reported abuse of elderly residents over the past year, as manifested in one or more of types of maltreatment. The total number of various types of maltreatment reported was 513. About two-thirds of the cases were incidents of neglect. Seventy per cent of respondents reported that they had been present at incidents in which another staff member abused an elderly resident in one or more types of maltreatment, and in such situations mental abuse and mental neglect were the most prevalent forms of maltreatment.
Conclusion and Recommendations:  This is the first study to examine elder maltreatment in the long-term care population of Israel. The research findings produce an expanded and improved research model investigating elder maltreatment in long-term nursing homes.     

Change in perceived psychosocial status following a 12-week Tai Chi exercise programme

AIM: This paper reports a study to examine change in psychosocial status following a 12-week Tai Chi exercise intervention among ethnic Chinese people with cardiovascular disease risk factors living in the United States of America. BACKGROUND: Regular participation in physical activity is associated with protection against cardioavascular disease, and improvements in physical and psychological health. Increasing amounts of scientific evidence suggests that mind-body exercise, such as Tai Chi, are related to improvements in mental health, emotional well-being, and stress reduction. No prior study has examined the effect of a Tai Chi exercise intervention on psychosocial status among people with cardiovascular disease risk factors. METHODS: This was a quasi-experimental study. Participants attended a 60-minute Tai Chi exercise class three times per week for 12 weeks. Data were collected at baseline, 6 and 12 weeks following the intervention. Psychosocial status was assessed using Chinese versions of Cohen's Perceived Stress Scale, Profile of Mood States, Multidimensional Scale of Perceived Social Support, and Tai Chi exercise self-efficacy. RESULTS: A total of 39 participants, on average 66-year-old (+/-8.3), married (85%), Cantonese-speaking (97%), immigrants participated. The majority were women (69%), with < or =12 years education (87%). Statistically significant improvements in all measures of psychosocial status were found (P < or = 0.05) following the intervention. Improvement in mood state (eta2 = 0.12), and reduction in perceived stress (eta2 = 0.13) were found. In addition, Tai Chi exercise statistically significantly increased self-efficacy to overcome barriers to Tai Chi (eta2 = 0.19), confidence to perform Tai Chi (eta2 = 0.27), and perceived social support (eta2 = 0.12). CONCLUSIONS: Tai Chi was a culturally appropriate mind-body exercise for these older adults, with statistically significant psychosocial benefits observed over 12-weeks. Further research examining Tai Chi exercise using a randomized clinical trial design with an attention-control group may reduce potential confounding effects, while exploring potential mechanisms underlying the relaxation response associated with mind-body exercise. In addition, future studies with people with other chronic illnesses in all ethnic groups are recommended to determine if similar benefits can be achieved.     

太极拳（剑）锻炼与中老年人心理健康的关系

目的研究太极拳（剑）锻炼与中老年人心理健康的关系。方法 120名受试者被分为锻炼组和对照组各60例。锻炼组即太极拳（剑）组,对照组为不参加任何形式的身体锻炼活动者,或虽参加锻炼活动但平均每周不足1次者。结果①积极锻炼者的心理健康指标明显优于不积极锻炼者。②太极拳（剑）锻炼对于中老年人数字广度的保持具有更积极的意义,表现为见效快,负荷小,非常适合老年人。③身体锻炼对延缓心理衰老的积极作用,可能在于其对参与者注意和意识状态的有效调整。结论身体锻炼对延缓心理衰老有积极作用。     

A randomized controlled trial of tai chi for tension headaches

This study examined whether a traditional low-impact mind–bodyexercise, Tai Chi, affects health-related quality-of-life (HRQOL)and headache impact in an adult population suffering from tension-typeheadaches. Forty-seven participants were randomly assigned toeither a 15 week intervention program of Tai Chi instructionor a wait-list control group. HRQOL (SF-36v2) and headache status(HIT-6^TM) were obtained at baseline and at 5, 10 and 15 weekspost-baseline during the intervention period. Statisticallysignificant (P < 0.05) improvements in favor of the interventionwere present for the HIT score and the SF-36 pain, energy/fatigue,social functioning, emotional well-being and mental health summaryscores. A 15 week intervention of Tai Chi practice was effectivein reducing headache impact and also effective in improvingperceptions of some aspects of physical and mental health.     

Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults

AIM: This paper reports a study to determine changes in the physical fitness (knee and ankle muscle strength, balance, flexibility, and mobility), fall avoidance efficacy, and fall episodes of institutionalized older adults after participating in a 12-week Sun-style Tai Chi exercise programme. BACKGROUND: Fall prevention has a high priority in health promotion for older people because a fall is associated with serious morbidity in this population. Regular exercise is effective in fall prevention for older adults because of improvements in strength and balance. Tai Chi exercise is considered to offer great potential for health promotion and rehabilitation, particularly in the maintenance of good mental and physical condition in older people. METHODS: A quasi-experimental design with a non-equivalent control group was used. Data were collected from September 2001 to January 2002. A total of 68 fall-prone older adults with a mean age of 77.8 years participated in the study, and 29 people in the Tai Chi group and 30 controls completed the post-test measures. The Tai Chi exercise programme was provided three times a week for 12 weeks in the experimental group. Data were analysed for group differences using t-tests. RESULTS: At post-test, the experimental group showed significantly improved muscle strength in knee and ankle flexors (P < 0.001) and extensors (P < 0.01), and improved flexibility (P < 0.01) and mobility (P < 0.001) compared with the control group. There was no significant group difference in fall episodes, but the relative risk ratio for the Tai Chi exercise group compared with the control group was 0.62. The experimental group reported significantly more confidence in fall avoidance than did the control group. CONCLUSION: The findings reveal that Tai Chi exercise programmes can safely improve physical strength and reduce fall risk for fall-prone older adults in residential care facilities.     

Prevalence of heart failure in nursing homes: a systematic literature review

Scand J Caring Sci; 2010; 24; 202–208
Prevalence of heart failure in nursing homes: a systematic literature review
Introduction:  Heart failure is an important problem in western countries. In nursing home residents heart failure is expected to be highly prevalent. However, accurate diagnosis of heart failure in these patients is often hampered due to atypical findings and concomitant co-morbidity. In order to deliver adequate nursing care and medical treatment, it is important to get insight into the prevalence of heart failure in this target group of patients.
Objectives:  To assess the prevalence of heart failure as well as the co-morbidity interfering with heart failure in nursing home residents.
Methods and results:  A systematic literature review was conducted in Medline, Embase, Cinahl and the Cochrane Library. Ten studies were ultimately included. Findings indicate that the mean prevalence of heart failure is 20% (range 15–45%) and that there is a significant level of co-morbidity (dementia, diabetes mellitus and chronic obstructive pulmonary disease) in nursing home residents with heart failure.
Conclusion:  The reported prevalence of heart failure in nursing home residents is higher than in the general population and is associated with considerably co-morbidity. However there are also indications that the prevalence of heart failure in nursing home residents is underestimated, negatively affecting quality of life and quality of care. Therefore, prospective prevalence studies and studies aiming to improve the care for nursing home residents with heart failure are warranted.     

Cultural Perspectives in Feeding Difficulty in Taiwanese Elderly With Dementia

Objective: To investigate factors related to feeding difficulty that is shown in the interaction between nursing assistants and elderly residents with dementia.
Methods: Forty-eight residents and 31 nursing assistants were observed during meal times in a congregate dining room of a Taiwanese nursing home specializing in dementia care. Residents' eating behaviors, the dining environment, interactions between the nursing assistant and the residents, and feeding strategies used by nursing assistants were observed. Nutritional data for residents were collected from medical charts. The EdFED Scale #2 and interviews of nursing assistants provided information about feeding difficulty. Interviews also provided data on strategies used to address feeding difficulties.
Findings: The most frequent feeding difficulty was refusal to eat (37.5%). The strategies used by nursing assistants were limited. Nursing assistants stated they needed more training to address feeding difficulty in residents with dementia.
Conclusions: Future research should be focused on the interface between the residents and nursing assistants who must identify various feeding difficulties and select appropriate interventions.
Clinical Relevance: Results might provide information that can be used to develop effective interventions and promote high-quality mealtime care in patients with dementia.     

End of life in an Icelandic nursing home: an ethnographic study

Aim: To examine care of the dying elderly in a nursing home in Iceland. Methods: An ethnographic study design was adopted. The study sample comprised all of the nursing home residents, their relatives, and all of the staff working in the nursing home, but with a particular focus on the 11 registered nurses (RNs) on the site. Data was collected through participant observation, semi-structured group interviews with the RNs, and an examination of the nursing home's official records. Underlying themes were discovered using interpretative phenomenology. Findings: Two main themes emerged: that palliative care is the most important element of care in the home, and that RNs are the pillars of caring for the dying elderly in the nursing home. Conclusions: The findings suggest that RNs' professional knowledge can greatly contribute to the care of dying elderly residents in nursing homes. There seem to be many parallels between the condition and wellbeing of very frail nursing home residents and patients in specialized palliative care units for the elderly. Public awareness of palliative care of the elderly in Icelandic nursing homes should be encouraged.     

The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing

Supporting the health of growing numbers of frail older adults living in subsidized housing requires interventions that can combat frailty, improve residents' functional abilities, and reduce their health care costs. Tai Chi is an increasingly popular multimodal mind–body exercise that incorporates physical, cognitive, social, and meditative components in the same activity and offers a promising intervention for ameliorating many of the conditions that lead to poor health and excessive health care utilization. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study is an ongoing two-arm cluster randomized, attention-controlled trial designed to examine the impact of Tai Chi on functional indicators of health and health care utilization. We are enrolling participants from 16 urban subsidized housing facilities (n = 320 participants), conducting the Tai Chi intervention or education classes and social calls (attention control) in consenting subjects within the facilities for one year, and assessing these subjects at baseline, 6 months, and 1 year. Physical function (quantified by the Short Physical Performance Battery), and health care utilization (emergency visits, hospitalizations, skilled nursing and nursing home admissions), assessed at 12 months are co-primary outcomes. Our discussion highlights our strategy to balance pragmatic and explanatory features into the study design, describes efforts to enhance site recruitment and participant adherence, and summarizes our broader goal of post study dissemination if effectiveness and cost-effectiveness are demonstrated, by preparing training and protocol manuals for use in housing facilities across the U.S.     

Decision-making for acutely ill nursing home residents: nurses in the middle

Title.  Decision-making for acutely ill nursing home residents: nurses in the middle.
Aim.  This paper is a report of a study to generate a model of nursing behaviours and social processes inherent in decision-making for acutely ill nursing home residents.
Background.  Most research concerning clinical decision-making in nursing homes focuses on the perspectives of doctors. Much less is known about the perspectives and actions of nurses with regard to decision-making, despite the centrality of their roles in nursing homes.
Method.  Grounded theory was used. Data were collected in 2004 in four nursing homes in the United States of America using in-depth, semi-structured interviews, 74 hours of non-participant observation and informal conversational interviews with key nursing staff involved in decision-making.
Findings.  Nurses strive to create a plan of care acceptable to family members and doctors, consistent with wishes of residents and most comfortable for residents. A unifying theme of satisfying all sides emerged as representative of the negotiation strategies used by nurses to address these competing points of view. Four phases in this negotiation occurred: weighing the significance ; notifying the family ; feeling it out ; and playing the middleman . The outcome was either a decision for life-prolongation or for palliative care.
Conclusion.  Decisions for nursing home residents are complex and involve weighing and balancing the interests and preferences of many concerned participants, including residents, families and doctors. This process requires skill in clinical judgment, communication and collaboration.     

The impact of daily exercise on the mobility, balance and urine control of cognitively impaired nursing home residents

The purpose of this intervention study was to examine the impact of a daily exercise regimen on the mobility, balance, and urine control of a sample of cognitively impaired elderly nursing home residents. A quasi-experimental pretest-posttest design was used with 15 elderly, cognitively impaired, incontinent nursing home residents. Data were collected regarding walking distance, speed of walking, balance ability, ability to rise from a chair unassisted, ability to walk unassisted, and incidence of urinary incontinence before and after a month of daily assisted walking. Subjects were able to walk significantly greater distances before tiring after the exercise regimen. In addition, the incidence of urinary incontinence was significantly decreased.     

改良太极运动对老年女性膝OA患者下肢肌力与心肺耐力的影响

目的:探讨为期12周的改良太极运动对老年女性膝骨关节炎患者下肢肌力及心肺耐力的影响.方法:将40例老年女性KOA患者采用数字随机法分为太极组(n=20)和对照组(n=20),进行为期12周的干预.在治疗前后进行表面肌电(sEMG)、心血管功能、肺功能检查和6分钟步行实验(6MWT)测试.结果:治疗12周后,与治疗前相比...     

Well-being of institutionalized elders after Yang-style Tai Chi practice

Aims and objectives. The purpose of this study was to examine the effects of Tai Chi on the physical and psychological well‐being of elders who resided in long‐term care facilities. Background. The beneficial effects of Tai Chi on elders’ well‐being have been well‐documented; however, most of the studies focused on community‐dwelling or healthier elders. Design and methods. In this longitudinal, time‐series, quasi‐experimental study, a convenience sample of 28 institutionalized elders was recruited. A six‐month Yang‐style Tai Chi intervention was administered twice a week for 60 minutes per practice. The well‐being outcome variables, including physical and mental health status, blood pressure, quality of sleep, occurrence of falls and fear of falling, were measured before the intervention and then at one‐month, two‐month, three‐month and six‐month intervals. Results. Results indicated that the physical health status and social functioning of frail elders were significantly improved after Tai Chi practice [F(4,24) = 3·42, p = 0·038; F(4,24) = 9·66, p = 0·001 respectively]. Conclusions. Tai Chi practice is beneficial for frail older people. Relevance to clinical practice. The findings provide a basis for using Yang‐style Tai Chi as a floor activity in long‐term care facilities to promote the well‐being of the older residents.     

A longitudinal evaluation of nursing home care quality in Taiwan

Aging populations worldwide have important implications for elderly care composition and quality, particularly with regard to care provided by nursing homes. Our study investigated quality of nursing home care in Taiwan using resident satisfaction and clinical outcomes as indicators. We randomly recruited 306 residents in 13 nursing homes and assessed them at initial, 3, 6,and 12-months follow-up. The outcomes of the nursing home care in the 12-month follow-up period showed significant decreases in pressure sores and moderate satisfaction of nursing home care, but increases in physical restraints and psychological loneliness. Study results suggest that long-term nursing home care may improve residents' quality of life. However, to achieve this, nursing homes must provide improved psychological support for residents and decrease the use of physical restraints.     

Joint kinetics during Tai Chi gait and normal walking gait in young and elderly Tai Chi Chuan practitioners

BACKGROUND: Tai Chi Chuan is becoming a popular exercise among elders. This study measured the inter-segmental forces and moments at the lower extremity joints during a Tai Chi gait as compared to those during normal walking gait, in both apparently healthy young and elderly Tai Chi Chuan practitioners. METHODS: Three-dimensional inter-segmental joint reaction force and moment were computed using the Inverse Dynamic Approach based on the kinematics and ground reaction force measurements in a laboratory setting in six young (two females, mean age 28; SD 6 years) and six elderly (five females, mean age 72; SD 8 years) subjects who had previous training of Yang style Tai Chi Chuan. FINDINGS: The results showed significant gait differences in both age groups, with significantly smaller peak compressive forces, larger peak shear forces in the ankle, knee and hip joints, and larger peak moments in the knee and hip joints during Tai Chi gait as compared to normal gait. Moreover, the peak shear force was oriented more in the medial-lateral direction at the ankle and knee joints, and the peak moment was in the frontal plane at the knee and hip joints. The results also showed significant age differences, with significantly smaller peak shear forces in all three joints in the elderly group than in the young group during Tai Chi gait. INTERPRETATION: Tai Chi gait has an increased shear force and frontal plane torque at lower extremity joints than normal gait. The shear force at all three lower extremity joints during Tai Chi gait is lower in the elderly subjects than young subjects. This data suggest that, in Tai Chi Chuan training, elderly people with degenerative joint diseases in the lower extremity should use caution when practicing Tai Chi Chuan.     

太极拳运动对社区老年人身心功能的影响

[目的]探讨太极拳运动对社区老年人身心功能的影响.[方法]采用问卷调查法和测量法,于2013年1月对长春市4个公园65岁以上太极拳组老年人（57人）、对照组（47人）进行身体功能（握力左手、握力右手、睁眼单侧腿站立、5 m快速步行速度和10 m正常步行速度、老年活动能力指标）、幸福感、简易智能状态量表（MMSE）的测定.[结果]太极拳组在老年活动能力指标、MMSE、握力左手、握力右手、睁眼单侧腿站立、5 m快速步行速度方面与对照组比较差异有统计学意义（P＜0.05）.[结论]太极拳运动可以改善老年人的身心功能.     

The quality of nursing home care in Taiwan

This study describes the quality of care in nursing homes in Taiwan using demographic data, functional status measures, resident clinical care outcomes, and resident's ratings of satisfaction with nursing home care. Three hundred and eight randomly selected elderly residents in 13 nursing homes were interviewed through a structured interview process and demographic and medical information was collected from their nursing home records. Nursing home residents were younger and less functional than their counterparts in the United States. Stroke and dementia were the most common primary diagnoses and more than 27% of the residents had a history of urinary tract infections while more than 25% had been physically restrained within the past 3 months. There was no correlation between the number of nursing home staff per resident and the prevalence of selected clinical care outcomes. A moderate level of satisfaction with nursing home care was reported with acceptance of family visits and nursing home cleanliness rating highest, and loss of personal belongings and life as boring rating lowest. Level of satisfaction with nursing home care was positively correlated with the number of RNs and nursing assistants (NAs) on staff. Recommendations for improving the quality of nursing home care in Taiwan include increased recruitment of multidisciplinary professional and technical nursing home staff; restrictions in the use of restraints with development of alternatives; and use of standardized resident assessment, care planning, and evaluation tools. The authors recommend continuing education in geriatric nursing and continued nursing research focusing on identifying structure and process variables that affect clinical care outcomes and satisfaction with nursing home care.     

The effects of integrated care on quality of work in nursing homes: a quasi-experiment

BACKGROUND: In nursing homes there is a gradual move from traditional care to integrated care. Integrated care means a demand-oriented, small-scale, co-operated and coordinated provision of services by different caregivers. This integration has direct effect on the work of these separate disciplines. With the introduction of integrated care the quality of work of these caregivers should be assured or even be improved. OBJECTIVES: The purpose of this study was to examine the implementation of integrated care in the nursing home sector and its effects on the quality of work of the caregivers (work content, communication and co-operation and worker's outcomes). DESIGN: A non-equivalent pre-test/post-test control group design was used in this study. SETTINGS AND PARTICIPANTS: Two nursing homes in the Netherlands participated in the study. One nursing home provided the five experimental nursing wards and the other nursing home provided four control wards. METHOD: Data were selected by means of written questionnaires. RESULTS: The results showed that the intervention appeared to be only successful on the somatic wards. The caregivers of these wards were more able to create a home-like environment for their residents, to use a demand-oriented working method and to integrate the provision of care and services. Regarding the effects of the intervention on quality of work factors, the results included an increase of social support by the supervisor, an increase of the degree of collaboration and a decrease in job demands. No changes were found for the worker's outcomes such as job satisfaction. CONCLUSIONS: The intervention on the psycho-somatic wards was unsuccessful. Although the introduction of integrated care on the somatic wards was successful, the effects on quality of work were limited. Next to quantitative research, more qualitative in-depth research is needed to examine models of integrated care and their effects on the work of caregivers within health care organisations, with special attention for specific characteristics of different types of nursing home care (somatic vs. psycho-geriatric).