Engagement of Residents of Assisted Living and Skilled Nursing Facility Memory Care Units

Lack of engagement has detrimental effects on the quality of life of residents, especially those with dementia. Yet the level of engagement of individuals in memory care units that had implemented the Pearls of Life® program (US program) had not been determined. Seventy-four residents of 13 skilled nursing and assisted living facilities were observed for 10 minutes during five planned activities to describe engagement levels and determine factors influencing engagement. Participants were engaged only about 50% of the time. Total engagement time was significantly associated with the number of engagement strategies used. There were several differences in the use of select strategies for the setting. The evaluation served as the basis for program refinement.     

Use of a Structured Life Review and Its Impact on Family Interactions

Communication is vital to our ability to provide quality end-of-life care. Although research has focused on communication between healthcare professionals and the patient/family unit, this qualitative study explored the impact of a life review technique on family interactions. Life review interviews were conducted with 33 participants (residents of a nursing facility and their family members). Follow-up interviews with participants identified potential impacts on family interactions. Themes that emerged included affirmation of prior knowledge, living legacy, new information, opened communication, enhanced understanding, affirmation of the older adult, testimonials, and bridging distant family relationships. A review of the themes and potential uses for this technique are discussed.     

Objective Control and Well-Being in Assisted Living Settings

Abstract

The present study sampled 85 residents of assisted living facilities and delineated two groups based on functional independence, or objective control. The groups were then compared on measures of life satisfaction and affective experience. No significant differences were found on these criteria, suggesting that personal control capabilities are less instrumental in determining well-being among this population. Implications include the possibility that assisted living arrangements for older adults may assuage the often-observed decline in well-being reported under conditions of lesser functional capabilities.     

Managing Everyday Ethics in Assisted Living: A Research-Based Case Analysis for the Classroom

ABSTRACT

This paper presents a complex, but realistic, picture of the lived experience in assisted living (AL), and provokes thoughtful reflection about the operational and ethical challenges faced in the delivery of care to an increasingly frail population in a typical AL facility. Developed from the findings of a two-year qualitative research project, the case represents a composite of selected data collected at five AL facilities that participated in the study. Students will participate in individual and small group exercises that challenge them to identify everyday ethical concerns in AL, and to suggest ways that management can address these issues. The case is suitable for cross-disciplinary use, and can be effectively applied in the fields of management, health care administration, sociology, gerontology, social work, and nursing, either on the graduate or undergraduate level. It is especially well suited to courses that incorporate the topics of long-term care, senior housing, or ethics.     

Using Life History Narratives to Educate Staff Members About Personhood in Assisted Living

Oral life history narratives are a promising method to promote person-centered values of personhood and belonging. This project used resident oral history interviews to educate staff members in an assisted-living setting about personhood. A single group pre-post test design evaluated impacts on 37 staff members to assess their use of resident videotaped oral history interviews and impacts on their perceived knowledge of residents. Perceived knowledge of residents declined (p = .003) between pretest and posttest. Older staff members were less likely to view a video. Staff members are interested in resident oral history biographies and identify them as helpful for delivering care. Oral history methods might provide an opportunity for staff members to promote personhood by allowing them to expand their understanding of resident preferences, values, and experiences.     

Impact of Pressure Ulcers on Quality of Life in Older Patients: A Systematic Review

OBJECTIVES: To identify the impact of pressure ulcers (PUs) and PU interventions on health-related quality of life (HRQL).
DESIGN: Systematic review and metasynthesis of primary research reporting the impact of PU and PU interventions on HRQL according to direct patient reports. Quality assessment criteria were developed and applied. Data extraction identified findings in the form of direct quotes from patients or questionnaire items and domain results. Combined synthesis of qualitative and quantitative research was performed using content analysis to generate categories and themes from findings. Thirteen electronic databases were searched, and hand searching, cross-referencing, contact with experts, and an online search was undertaken. No language restrictions were applied.
SETTING: Adults with PUs in acute, community, and long-term care settings across Europe, the United States, Asia, and Australia.
PARTICIPANTS: Thirty-one studies including 2,463 participants with PUs were included in the review. Ages ranged from 17 to 96.
RESULTS: The review included 10 qualitative and 21 quantitative studies; 293 findings, 46 categories, and 11 themes emerged. The 11 HRQL themes were physical impact, social impact, psychological effect, PU symptoms, general health, and other impacts of PUs: healthcare professional–client relationships, need for versus effect of interventions, impact on others, financial impact, perceived etiology, and need for knowledge.
CONCLUSION: There is evidence that PUs and PU interventions have a significant impact on HRQL and cause substantial burden to patients.     

The Legacy Project Intervention to Enhance Meaningful Family Interactions: Case Examples

Manualized reminiscence and life review therapies are supported as an evidence-based, effective treatment for depression among older adults, but this therapeutic approach is usually individually administered and has rarely been applied in palliative care settings. We combined mutual reminiscence and life review with engagement in meaningful activity and examined the efficacy of this family-based dyadic intervention to decrease caregiving stress and increase family communication. Seventeen individuals living with chronic, life-limiting illnesses in the community and their family caregivers received three home visits with a Master's level interventionist. During these sessions and through structured homework activities, the interventionist actively worked with the family to construct a personal Legacy Project, usually a scrapbook with photos, a cookbook, or audiotaped stories that celebrated the life of the ill individual. All participants in the intervention group initiated a Legacy Project and reported that Legacy activities improved family communication. Participation in Legacy creation also resulted in increased positive emotional experiences in patient and caregiver groups. These results are illustrated through careful examination of three case studies.     

Living Legends: Students' Responses to an Intergenerational Life Review Writing Program

The purpose of the study was to examine the effects of participation in the Living Legends program upon health science students' image of older adults and interest in working with older people. A multisite quasi‐experimental control group design with a connected qualitative component was used. Program sites included three Naturally Occurring Retirement Communities (NORCs) and one senior center. Health science students (n = 43) from two universities and two community colleges and community‐dwelling seniors (n = 39) participated in the program. A baseline questionnaire was used to ascertain demographic characteristics and prior type and amount of contact with older adults. The Image of Aging Scale and Likert‐style questions to measure interest in working with older adults were the primary outcome measures. Written responses to program experiences were also collected. Analysis of covariance was used to compare changes in Image of Aging subscale scores from pre‐ to posttest. Mean change in positive image of older adults subscale scores was 4.6 (SD = 4.4) for the intervention group and ?0.6 (SD = 4.8) for the control group. The difference between groups was significant (F = 22.0, P < .001), and the effect size was large (Cohen's d = 1.07). Nine of the 22 students in the intervention group had a greater interest in working with seniors after the program. Qualitative themes that emerged included a positive and beneficial experience, life lessons, seeing the person beyond the visible, power of the written word, and shared lives. Living Legends is an effective program to enhance positive images of older adults in future healthcare professionals and may have a positive impact on some students with regard to interest in working with older adults.     

Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review

The development of metabolic derangements as a result of HIV treatment has been an important area of research since the introduction of zidovudine in the 1980’s. Antiretroviral therapy has intensely evolved in the last three decades, with new drugs gradually incorporated into everyday clinical practice. With the life expectancy of people living with HIV rapidly approaching that of their HIV-negative counterparts, the influence of these antiretrovirals on the development of the components of the metabolic syndrome remains of major interest to clinicians and their patients. In this review, we aimed to discuss the impact of cART on components of the metabolic syndrome, i.e., weight, plasma lipid levels, plasma glucose levels, and blood pressure, describing the influence of cART classes and of individual antiretrovirals. We also aimed to outline the limitations of the research conducted to date and the remaining knowledge gaps in this area.     

The Impact of Diabetic Neuropathy on Activities of Daily Living,Postural Balance and Risk of Falls - A Systematic Review

Objective:The objective of this review is to discuss a compilation of the currently available literature regarding the impact of diabetic neuropathy (DN) on activities of daily living (ADL), postural stability, and risk of falls.Methods:A systematic electronic search strategy was conducted on PubMed/MEDLINE database, Cochrane Library, and Embase in March 2020. This narrative review included clinical cross-sectional studies assessing ADL, postural balance, and falls in adults with DN. All studies underwent a quality assessment based on the Newcastle Ottawa scale developed to assess cross-sectional studies.Results:Forty-two studies were identified. A total of 37 studies evaluated postural stability in DN, 10 studies assessed fall accidents, and three studies assessed ADL in individuals with DN. Seven studies assessed both postural stability and fall accidents, and one study assessed postural stability and ADL. Each of the studied outcome variables was assessed separately. Based on a quality assessment, eight studies were excluded resulting in an evaluation of 34 studies.Conclusions:Diabetic neuropathy has a negative impact on postural balance and gait kinematics combined with an increased fall risk. Because of the few number of studies available, we were unable to evaluate the impact of DN on ADL. Our findings are in concordance with previous reviews, supporting the evidence for DN as a critical measure negatively impacting postural stability and fall risk in individuals with diabetes. Further clinical investigative studies are needed.     

Assessment of the Impact of Shot-Peening on the Fatigue Life of a Compressor Blade Subjected to Resonance Vibrations

This publication presents an assessment of the influence of a surface treatment such as shot-peening on the fatigue life of a compressor blade exposed to resonant vibrations. As part of the work, a geometric model of the blade was developed, and a numerical modal and fatigue analysis were performed. The fatigue analysis was based on the Manson–Coffin–Basquin and Ramberg–Osgood models. Additionally, the location of the highest equivalent stresses was established. Based on the results of the strength analysis, two points were identified where a fatigue crack may potentially occur. As part of the work, the influence of different values of residual stresses on the results of the fatigue life was determined. The obtained results were compared to the literature values of fatigue life for this blade. A secondary objective of the study was to determine the size of the grains at various points of the blade, as well as the thickness of the layer plasticized as a result of peening. The relationship between the location of the highest values of the equivalent stresses and the thickness of the plasticized layer was determined. An explanation of the effect of shot-peening on the increase in the fatigue life of the blade was proposed.     

A Review on the Life Cycle Assessment of Cellulose: From Properties to the Potential of Making It a Low Carbon Material

The huge plastic production and plastic pollution are considered important global issues due to environmental aspects. One practical and efficient way to address them is to replace fossil-based plastics with natural-based materials, such as cellulose. The applications of different cellulose products have recently received increasing attention because of their desirable properties, such as biodegradability and sustainability. In this regard, the current study initially reviews cellulose products’ properties in three categories, including biopolymers based on the cellulose-derived monomer, cellulose fibers and their derivatives, and nanocellulose. The available life cycle assessments (LCA) for cellulose were comprehensively reviewed and classified at all the stages, including extraction of cellulose in various forms, manufacturing, usage, and disposal. Finally, due to the development of low-carbon materials in recent years and the importance of greenhouse gases (GHG) emissions, the proposed solutions to make cellulose a low carbon material were made. The optimization of the cellulose production process, such as the recovery of excessive solvents and using by-products as inputs for other processes, seem to be the most important step toward making it a low carbon material.     

Impact of Familial Adenomatous Polyposis on Young Adults: Quality of Life Outcomes

Purpose This study used a novel questionnaire to assess quality of life and psychologic adjustment among young adults aged 18 to 35 years with a diagnosis of, or at risk of, developing familial adenomatous polyposis. Methods Eighty-eight participants (25 males) were recruited through four Australian Hereditary Bowel Cancer Registries. Results The average age of participants was 28 years, and the average age of these participants at the time of their last genetic consultation was 23 years. Seventy-one participants (81 percent) had clinical familial adenomatous polyposis, of whom 57 had undergone an ileorectal anastomosis or formation of an ileal pouch with anal anastomosis to prevent colorectal cancer. The ileal-pouch-with-anal-anastomosis group had significantly more adverse outcomes for physical functioning, body image, sexual impact, and negative affect compared with the no-surgery group—and significantly more negative outcomes for physical functioning and negative affect compared with the ileorectal-anastomosis group. Among the total sample, a small proportion (11.4 percent) had avoidance scores indicative of a significant stress response, and being single was associated with higher levels of avoidance responses about familial adenomatous polyposis (z = −3.19; P = 0.001). Conclusions Familial adenomatous polyposis may have a negative impact across a broad range of life domains. Being single is an important risk factor for adverse psychologic outcomes. Delaying surgery, especially ileal pouch with anal anastomosis may minimize the negative impact on physical and psychologic functioning. Referral for psychologic intervention may be required for a small proportion of those affected by familial adenomatous polyposis, and ongoing access to genetic services may help to identify and address the needs of this group. Poster presentation at International Congress of Human Genetics, Brisbane, Australia, August 6 to 10, 2006; the International Meeting on Psychosocial Aspects of Genetic Testing for Hereditary Cancer, Philadelphia, Pennsylvania, June 9 to 10, 2005; and Australia Gastroenterology Week, Adelaide, Australia, October 11 to 14, 2006. Presented at the Kathleen Cuningham Consortium for Familial Aspects of Breast Cancer Meeting, Queensland, Australia, August 30 to September 3, 2005; and the Conference of the International Society for Gastrointestinal Hereditary Tumors, Newcastle, United Kingdom, June 14 to 17, 2005. Funded by the Cure Cancer Foundation of Australia. Bettina Meiser is supported by a Career Development Award from The National Health and Medical Research Council of Australia (ID 350989). Reprints are not available.