Transition to residential care: experiences of elderly Chinese people in Hong Kong

A qualitative study was designed to explore the experiences of transition into residential care among elderly Chinese people in Hong Kong. With the elderly people's consent, in-depth interviews were conducted with 10 residents 1 week after their admission into a residential care home. The purpose of the interviews was to explore what the transition experience was like for the Chinese elders and how they settled into residential life. Content analysis of the interview data revealed the significance of cultural influences in the transition experiences. A number of issues suggested in the literature as barriers to adjustment to residential care, such as living with rules and regulations, lack of privacy and autonomy were not regarded as important by the Chinese elders. The Chinese values of balance, harmony and collectivism have made it easier for them to remain open and accept the communal way of living. Yet, these same values have restricted the elders in developing new relationships with staff and other residents. This appears to be the particular challenge facing Chinese elderly residents. Implications for professionals working with elderly residents are discussed in the light of these findings.     

Resident and family member perceptions of cultural diversity in aged care homes

Similar to many developed nations, older people living in residential aged care homes in Australia and the staff who care for them have become increasingly multicultural. This cultural diversity adds challenges for residents in adapting to the care home. This study explores: (i) residents' and family members' perceptions about staff and cultural diversity, and (ii) culturally and linguistically diverse residents' and family members' experiences. An interpretive study design employing a thematic analysis was applied. Twenty‐three residents and seven family members participated in interviews. Four themes were identified from interpreting residents and family members' perceptions of the impact of cultural diversity on their adaptation to aged care homes: (i) perceiving diversity as an attraction; (ii) adapting to cross‐cultural communication; (iii) adjusting to diet in the residential care home; and (iv) anticipating individualized psychosocial interactions. The findings have implications for identifying strategies to support staff from all cultural backgrounds in order to create a caring environment that facilitates positive relationships with residents and supports residents to adjust to the care home.     

A review of older people''s experiences with residential care placement

BACKGROUND: Transition to the care and environment of a residential home has been identified in the literature as the most significant relocation affecting older people. However, little effort has been made systematically to review and synthesize the body of knowledge relating to older people's experiences with such placement. This has led to lack of concerted effort in the development of strategies to help elders adjust to such placement with dignity and success. AIM: This paper presents a critical review of the literature related to older people's experiences with residential care placement, with an attempt to identify how knowledge in this area could be moved forward. CONCLUSIONS: It is concluded that, while understanding of older people's pre and postplacement experiences was abundant, there was a dearth of literature on the actual experiences involved as older people made their day to day adjustment after placement. There is a need for future research to identify the dynamic processes of how older people come to terms with residential living. Future research should also focus on developing an accurate understanding of the adjustment experiences of elders with different ethnic background.     

Recognition of depression by staff in nursing and residential homes

Newly admitted residents in long-term care facilities are particularly vulnerable to depression and the early recognition and treatment of depression is therefore crucial around the time of admission to a home. Staff from 30 nursing and residential homes were asked to assess newly admitted residents for depression using HoNOS 65+ and their responses were compared with residents' scores on the Geriatric Depression Scale (GDS-15). The findings indicated low levels of recognition by staff, with rates ranging from 15% to 27% of those identified as depressed, depending on the definition of depression used. There was no statistically significant difference in the rate of recognition between nursing staff and other care staff. A staff survey conducted in the 30 study homes indicated that fewer than 2% had received specific in-service training on depression in older people. The findings suggest that more needs to be done to raise staff awareness of depression in residents of nursing and residential homes, particularly in newly admitted residents.     

Building relationships in residential long-term care: determinants of staff attitudes toward family members

The objective of this study was to identify staff-, family-, facility-, and resident-level predictors of staff attitudes toward family members. Data were used from 41 care staff members recruited from 5 nursing homes, 5 assisted living facilities, and 16 family care homes. A multiple regression model found that staff who reported greater quality in their relationships with residents also tended to indicate more positive perceptions of family members. The findings emphasize the need to consider family, resident, and staff relationships in concert when designing and implementing nursing interventions to improve quality of life and care in residential settings.     

Personal,social and cultural factors affecting elders' transitions to long term care: Certified nursing assistant perspectives

A focus group methodology was employed to elicit information from Certified Nursing Assistants (CNAs) about their views of the personality, social, institutional and cultural factors that affect the success or failure of elders' adaptation to nursing home life. The focus group (N = 6) was conducted in one long-term care facility. CNAs identified three themes that represent the process of successful adaptation to the nursing home. Emotional displacement was followed by a period of assimilation and acceptance. Resident personality, social, institutional and cultural characteristics that may affect each stage of the process are described. This study supports previous findings regarding the contribution of social-environmental elements in the adjustment process. CNA perceptions of factors that assist elders during the transition process proved to be a valuable source of information.     

失能老年人的年龄及自理能力对家庭照顾者负担的影响

目的探讨失能老年人的年龄、失能程度对家庭照顾者负担的影响。方法通过整群抽样,采用KatzADL、照顾者负担问卷(CBI)、自制的一般资料问卷对203例失能老年人及其家庭照顾者进行面对面调查。结果失能老年人家庭照顾者负担总分为(31.56±18.51)分,95.6%的家庭照顾者为轻度至中度负担;60~74岁年轻老年人的照顾者负担重于75~89岁老老年人和≥90岁长寿老年人的照顾者负担,年轻老年人的照顾者负担主要表现为较重的时间依赖性负担、发展受限性负担及身体性负担;完全失能老年人的照顾者负担高于部分失能老年人照顾者,表现为较高的时间依赖性负担、发展受限性负担、身体性负担以及情感性负担。结论失能老年人家庭照顾者普遍存在轻度至中度负担。年轻老年人、重度失能老年人的家庭照顾者负担更重,均以较重的时间依赖性负担、发展受限性负担、身体性负担为特点,后者还体现为较重的情感性负担。     

Outcomes of Cardiac Arrest in Residential Care Homes for the Elderly in Hong Kong

Objective: Studies done in the 1990's suggested nursing home residents with cardiac arrest had minimal chance of survival and resuscitation was not recommended. More recent studies showed opposing results. In Hong Kong, the proportion of elderly living in the residential care homes for the elderly is increasing. There is no study of out-of-hospital cardiac arrest outcomes in this population. This study aimed at evaluating the prognosis of out-of-hospital cardiac arrest occurring in the residential care homes for the elderly. It is hoped that the findings may inform the local emergency medical service concerning the issue of futility of resuscitating the residents with cardiac arrest in the residential care homes. Methods: This study was a retrospective analysis of a database of all patients aged 65 years or above with atraumatic out-of-hospital cardiac arrest and who were attended by the emergency medical service in a 12-month period. Data in the database were prospectively collected by the emergency medical service. The characteristics of patients and cardiac arrests, timeliness of the emergency medical service, and survival were analyzed. Comparison was made between elderly living in and not living in the residential care homes. Predictors of survival were evaluated with logistic regression. Results: 3919 patients aged ≥ 65 years were analyzed. There were 1506 cases of cardiac arrest occurring in the residential care homes for the elderly. Resuscitation was discontinued at the emergency department in over 70% of these cases. The survival to hospital admission rate and the 30-day survival rate were 9.6% and 0.3% respectively. Both were lower than patients not residing in the residential care homes. Younger age, witnessed arrest, bystander defibrillation, and shorter call to ED interval were associated with higher chance of surviving to hospital admission. Conclusion: Elderly suffering from cardiac arrest in residential care homes had a poor chance of survival. Except age, witnessed arrest, bystander defibrillation, and call to ED interval are modifiable predictors of survival. It is inappropriate to declare that resuscitating elderly in residential care homes is futile unless those factors have been fully addressed.     

Preferences and priorities for ongoing and end-of-life care: A qualitative study of older people with dementia resident in care homes

Background

The older person with dementia has a limited life expectancy and the dying trajectory can be protracted and unpredictable. For good end-of-life care, early communication, exploration of residents’ wishes, and identification of someone who can represent them, are important. In care homes the timing of these discussions, and who is involved is variable. Person-centred approaches to dementia care assume that people with dementia can actively participate in decisions about their lives. Less well understood is how this can inform end-of-life care decision making and complement information provided in advance care plans completed prior to, or at the point of admission to a care home.

Objectives

To explore how older people with dementia discuss their priorities and preferences for end-of-life care.

Methods

An exploratory, qualitative study that used guided conversations with 18 people with dementia, living in six care homes. Participants were asked about their life in the care home, their health, thoughts for the future, and wishes surrounding end of life. Data were analysed thematically.

Results

People with dementia's accounts of life in the care home, what they valued, and the impact of having dementia on how they participated in decision making, provided key insights into care preferences. Three linked themes that had relevance for thinking and talking about end of life were identified: “dementia and decision making”, “everyday relationships” and “place and purpose”. Older people with dementia's accounts of everyday experiences of care, key relationships with family and care home staff members and whether they accepted the care home as their home demonstrated what was important for them now and for the future.

Conclusion

For older people living with a diagnosis of dementia, the experience of living and dying in a care home is inextricably linked. End-of-life care planning and decision making by health care professionals, care home staff and family could be enriched by exploring and documenting the preoccupations, key relationships and wishes about everyday care of people with dementia.     

Evaluation of using the Chinese version of the Spirituality Index of Well-Being (SIWB) scale in Taiwanese elders

PurposeSpirituality and spiritual well-being have emerged as important indicators for one's quality of life and health outcomes. Nursing as a profession is concerned with a holistic approach to improve health and overall well-being. To evaluate the outcomes of holistic nursing interventions, using valid and reliable instruments to assess spiritual well-being becomes necessary. There is a lack of instruments for measuring spiritual well-being in Chinese populations. Little has been known about the feasibility of using the Spirituality Index of Well-Being (SIWB) in Taiwanese elders. The purpose of this cross-sectional study was to evaluate the uses of the translated Chinese version of the Spirituality Index of Well-Being (SIWB-C) with Taiwanese elders.MethodsA total of 150 individual who were 65 years old or older and living in southern Taiwan were recruited from a public community center. A four-step procedure was used to translate the English version of the SIWB to the traditional Chinese language. Internal consistency, factor analysis, and correlation coefficient were conducted to evaluate the reliability and validity of the SIWB-C.ResultsThe SIWB-C demonstrated a high internal consistency with Cronbach's alpha .95. The construct validity of SIWB-C was supported by factor analysis and by significant correlations with its subscales and the CES-D scale.ConclusionThe psychometric analysis indicates that the SIWB-C is a valid and reliable instrument for measuring spiritual well-being. This instrument provides a feasible and valid approach for assessing Taiwanese elders' spiritual well-being in the future.     

莘庄社区高龄老人医疗护理计划试点实践与体会

目的：积极应对上海人口老龄化, 完善社会养老服务体系,保障高龄老人得到居家医疗护理服务。方法：从2013年8月起,根据“上海市高龄老人医疗护理计划试点工作的通知”要求,莘庄镇纳入上海市六个试点街镇之一,由社区卫生服务中心医护人员对符合条件的户籍、年龄80周岁以上、参加本市城镇职工基本医疗保险的老人根据需求提供上门评估,根据评估结果,由护理站为老人提供居家医疗护理服务。结果：通过近三年的试点,有396位高龄老人提出了服务申请,经评估目前有181位老人在享受居家医疗护理服务,主要以基础护理项目为主,临床护理项目相对开展偏少。结论：试点工作虽然取得了一定的成效,但高龄老人护理人才队伍整体业务能力不高,急需提高。     

A diabetes education initiative for residential care home staff

About one in eight elderly people living in residential care homes will be known to have diabetes. Lack of appropriate training for care home staff is an important barrier to improved care for this vulnerable and neglected group. A multidisciplinary, multi-agency group have begun to address this problem with a district-wide diabetes education programme for care home staff.     

Incidence of violence towards staff caring for the elderly

A survey study concerning violence was conducted among staff (n=506) working with the elderly in residential settings and ordinary homes. The major aim of the study was to investigate the incidence of violence directed towards staff by elderly people living in residential settings. Furthermore, associations between the number of violent incidents and gender, age, year in service, year at present place of work, education of the staff, type of setting, the frequency and type of violence as well as the emotional reactions expressed by the staff should be examined. Forty percent of the staff was exposed to violence during the preceding year and 18% noted incidents of violence daily. A significantly larger proportion of staff working in nursing homes registered violence compared with those working in other types of settings. Physical violence was the most common (76%) type of violence. Powerlessness, sadness, anger and feelings of insufficiency were the most dominant feelings among staff facing by violent situations. Our results point to the necessity to further study caregivers' perception of patient violence and its impact on the quality of care.     

"Nobody ever asked me before": understanding life experiences of African American elders.

With the unprecedented growth in the African American elderly population, there exists an urgent need to prepare nurses to deliver culturally competent care. The purpose of this study was to increase the knowledge available about the cultural heritage, worldviews, and life experiences of African American elders. Reminiscence interviews were conducted with African American elders living in a medium-sized northeast urban community. Data were analyzed using Spiegelberg's phenomenological Method. The following themes emerged: (a) nobody ever asked me before, (b) stories of discrimination, (c) coping with discrimination, (d) the hurt of discrimination, and (e) self-discoveries. Nurses, through the use of reminiscence, can gain insight into the cultural heritage, worldviews, and life experiences of African American elders and improve their ability to deliver culturally competent care to this population.     

Perceived enactment of autonomy and related factors among elders

This study aims to investigate the perceived enactment of autonomy (PEA) of Chinese elders as well as its relationship to other variables, such as morale, life satisfaction, need for assistance, subjective overall health status, etc. Selected demographic attributes (gender, age, living arrangements, etc.) were also examined for their relationship to PEA. A purposive sample of 324 subjects over 64 years old was recruited from homes and long-term care facilities in southern Taiwan. A Chinese version of the PEA scale (PEA-CV) and the Revised Philadelphia Geriatric Center Morale Scale (R-PGCMS) were used to measure PEA and morale. Data were analyzed using SPSS/PC software version 10.0. The results show that these elders had high perceived enactment of autonomy (mean = 2.99). Through multiple regression analysis, these results also revealed that need for daily living assistance, type of living arrangement, scores for morale and marital status significantly affected perceived enactment of autonomy among Chinese elders. The results suggest that we should help elders recognize possible choices, respect the choices they have made, advocate elders' autonomy while providing assistance, and design appropriate activities for them so that they gain a sense of freedom, individuality and independence. Directions for future studies are suggested.     

Beyond Control: Staff Perceptions of Accountability for Children and Youth in Residential Group Care

This article explores the perceptions of residential staff teams regarding the concept of accountability for children and youth living in group care situations. Using a qualitative research approach, the authors held focus groups with residential staff teams in children's mental health and private group care facilities and then interviewed the supervisors separately in an effort to explore how these teams conceive of their responsibility to teach children and youth about accountability, as well as in order to determine the specific tools used and approaches taken for this purpose. The authors found that a strong reliance on control-based approaches persists and that, furthermore, very little conceptual or theoretical thinking informs team discussions or approaches to holding children and youth accountable for their actions. It is argued here that there is an urgent need to seriously engage with residential care providers about the lived experiences of children and youth under conditions. The use of control and vigilance around the enforcement of program expectations are rarely focused on the individual needs of the clients and typically reflect the intuition or “common sense” of residential staff teams instead.