Restraint use in older adults in home care: A systematic review

ObjectivesTo get insight into restraint use in older adults receiving home care and, more specifically, into the definition, prevalence and types of restraint, as well as the reasons for restraint use and the people involved in the decision-making process.DesignSystematic review.Data sourcesFour databases (i.e. Pubmed, CINAHL, Embase, Cochrane Library) were systematically searched from inception to end of April 2017.Review methodsThe study encompassed qualitative and quantitative research on restraint use in older adults receiving home care that reported definitions of restraint, prevalence of use, types of restraint, reasons for use or the people involved. We considered publications written in English, French, Dutch and German. One reviewer performed the search and made the initial selection based on titles and abstracts. The final selection was made by two reviewers working independently; they also assessed study quality. We used an integrated design to synthesise the findings.ResultsEight studies were reviewed (one qualitative, seven quantitative) ranging in quality from moderate to high. The review indicated there was no single, clear definition of restraint. The prevalence of restraint use ranged from 5% to 24.7%, with various types of restraint being used. Families played an important role in the decision-making process and application of restraints; general practitioners were less involved. Specific reasons, other than safety for using restraints in home care were noted (e.g. delay to nursing home admission; to provide respite for an informal caregiver).ConclusionsContrary to the current socio demographical evolutions resulting in an increasing demand of restraint use in home care, research on this subject is still scarce and recent. The limited evidence however points to the challenging complexity and specificity of home care regarding restraint use. Given these serious challenges for clinical practice, more research about restraint use in home care is urgently needed.     

Effect of reminiscence therapy on depression in older adults: a systematic review

The objective of this systematic review is to provide healthcare professionals with information to assist in their decision to utilize reminiscence therapy for depression reduction in older adults outside of the primary care setting. Nine reviewed studies that were randomized controlled trials not only varied in person, outcome measurement, control, and exposure/intervention, the results of these studies were also diverse. About half of these studies showed that reminiscence therapy resulted in statistical significantly decrease in depression. Despite that reminiscence therapy requires further testing, it should be considered as a valuable intervention. Future directions of studies on reminiscence therapy are suggested.     

State of the science: alleviating mealtime difficulties in nursing home residents with dementia

Three million people will reside in nursing homes (NH) in the United States, and over 50% will experience some level of dementia by 2030. People with dementia become increasingly dependent on others to manage mealtime difficulties and oral intake as the disease progresses. The purpose of this review is to explore the state of the science related to assisted hand-feeding of people with dementia in the NH, identify gaps, and inform future policy. The review was conducted in 2010 and identified sources from journal articles, websites, and other related publications. Results are presented around key themes of characteristics, measurements, related factors, and interventions for alleviating mealtime difficulties in people with dementia. Though in the early stages, international and interdisciplinary research interest exists to understand mealtime difficulties and effective intervention strategies. Health care providers must be able to identify problems and intervene appropriately to alleviate mealtime difficulties.     

Effects of self-management support programmes on activities of daily living of older adults: A systematic review

BackgroundThe ability of older adults to carry out activities of daily living and to adapt and to manage their own life decreases due to deterioration of their physical and cognitive condition. Nurses and other health care professionals should support the self-management ability of older adults to prevent activities of daily living dependence and increase the ability to adapt and to self-manage the consequences of living with a chronic condition.ObjectiveTo gain insight into the evidence of the effects of self-management support programmes on the activities of daily living of older adults living at home.DesignA systematic literature review of original research publications.Data sourcesSearches were performed in PubMed, CINAHL, PsychInfo, EMBASE and the Cochrane Central Register of Controlled Trials (in February 2016). No limitations were applied regarding date of publication, language or country.Review methodsPublications were eligible for this review on condition that they described a self-management support programme directed at adults of on average 65 years or older, and living in the community; used a randomized control group design; and presented information about the effects on activities of daily living. The methodological quality of the included studies was independently assessed by the authors using the quality criteria for reviews of the Cochrane Effective Practice and Organisation of Care Review Group. A best evidence synthesis was performed using guidelines provided by the Cochrane Collaboration Back Review Group.ResultsA total of 6246 potentially relevant references were found. After screening the references, 12 studies with a randomized controlled trial design were included. The methodological assessment of the 12 studies indicated variations in the risk of bias from low (n = 1) to unclear (n = 3) and high (n = 8). Although there was considerable variation in study population, intervention characteristics and measurement instruments used, most studies (n = 11) showed effects of self-management support programmes on the activities of daily living of older adults.ConclusionsThere is a moderate level of evidence that self-management support programmes with a multi-component structure, containing disease-specific information, education of knowledge and skills and, in particular, individually tailored coaching, improve the activities of daily living of older adults.Further research is required to gain insight into the most appropriate context and approach of self-management support interventions targeting activities of daily living of older adults living in the community.     

Interventions to support people with dementia and their caregivers during the transition from home care to nursing home care: A systematic review

BackgroundDuring the transition of people with dementia from home to nursing home family caregivers often feel burdened.ObjectivesWe aimed to 1) identify interventions which support people with dementia and their caregivers in the transition from home care to nursing home care, 2) synthesize the evidence for efficacy of these interventions, and 3) examine whether the identified interventions have been systematically developed, evaluated and implemented according to the Medical Research Council guidance on complex interventions.DesignA systematic review of randomised controlled trials was conducted according to the recommendations specified in the Cochrane Handbook for Intervention Reviews. The review protocol was registered in PROSPERO (2015: CRD42015019839). Reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement.Data sourcesMEDLINE, CENTRAL, PsycINFO, CINAHL, OTseeker, and PEDro, were searched. Other sources included Google Scholar, and ALOIS.Review methodsTwo reviewers independently assessed the eligibility of the articles. Data extraction was performed by one reviewer and verified independently by another. The Cochrane Risk of Bias tool was used for critical appraisal. Development and evaluation of the identified interventions were assessed, taking the Medical Research Council guidance into account. Review findings were synthesized narratively.ResultsThe search yielded 1278 records. Five studies were included, all conducted in the United States (4 RCTs and 1 cRCT with a total of 695 participants). The psychosocial interventions were individual and family counseling via telephone or ad hoc all of which addressed only informal caregivers. The intervention components, content and mode of delivery differed widely with inconsistent results. Significant intervention effects were found for the reduction of caregivers’ depressive symptoms, burden, feeling of guilt, emotional distress, overload, and interactions with staff. Other outcomes, i.e. stress, placement adaptation, role overload, and role captivity, were not statistically significantly affected. The assessment for bias risk across studies varied from moderate to low. Only two studies tested the feasibility of the intervention before full scale evaluation, none evaluated the implementation process according to the Medical Research Council framework.ConclusionsWe identified only a few studies with heterogeneous outcomes; evidence regarding the effectiveness of psychosocial interventions is thus insufficient. Further research is needed focusing on the development and evaluation of complex psychosocial interventions and more well-designed RCTs with larger sample sizes based on a rigorous methodology. Reporting on feasibility and implementation processes of interventions should be guaranteed, since it is crucial to evaluate transferability across care settings.     

Effects of music intervention on sleep quality of older adults: A systematic review and meta-analysis

BackgroundMusic interventions have several benefits for sleep quality. However, the effects of music interventions on sleep quality in older adults are controversial.ObjectiveTo summarize and evaluate the efficacy of music interventions on sleep quality in older adults.MethodsThe Cochrane Library, Embase, PubMed, Web of Science and Chinese National Knowledge Infrastructure (CNKI) were systematically retrieved until June 2020, updated on March 13, 2021. Both experimental and quasi-experimental studies were included if they evaluated the efficacy of music interventions on sleep outcomes in older adults. The methodological quality was assessed by the Cochrane RoB 2.0 and ROBINS-I Tool. The random effects models and effect measure (MD) were adopted, and sensitivity analysis by omitting each study was conducted to explore the source of heterogeneity.ResultsA total of 489 participants from 9 studies met the inclusion criteria. 6 studies were included in meta-analysis and sensitivity analysis, and 3 studies were included in the qualitative analysis. Main concerns about risk of bias were lack of blinding participants and investigators, and confounding factors might exist in non-RCTs. The Post-hoc meta-analysis indicated that music interventions might have a positive effect on sleep quality [MD = −2.64, 95 % CI (−3.76, −1.53), p < 0.001; I² = 75.0 %]. Only one study evaluated adverse events and reported zero discomfort.ConclusionsThe results indicated that music interventions might be beneficial for improving sleep quality, especially in sleep latency, sleep duration, sleep efficiency and sleep of daytime dysfunction in elderly individuals.     

Reducing depression among community-dwelling older adults using life-story review: A pilot study

A life-story review can serve as an effective intervention to express one's inner feelings and provide emotional catharsis. The research aim was to examine the effects of life-story review on depression levels in community-dwelling older adults in Singapore. This pilot experimental pre-post-follow-up study was conducted from July 2012 to February 2013. Twenty-nine older Malays aged 60 and above, with mild to moderate depression, were randomly allocated to the life-story review (intervention) group (n = 15) or the non life-story review (control) group (n = 14). Depressive symptoms were measured by the Geriatric Depression Scale-15 and collected five times over eight weeks. Generalized estimating equations were used to examine the effects of the intervention on the elders' depression levels, controlled for age, gender, medication use, existence of chronic disease, and diary writing experience. Reductions in depression scores were found in the intervention group from week 1 (Mean ± SD 5.9 ± 2.3) to week 8 (1.9 ± 1.6) compared with the control group (week 1: 5.0 ± 1.3; week 8: 3.5 ± 1.5). At week 8, the intervention group showed a significantly lower level of depression than the control group (χ² = 14.61, p < 0.001). This study adds to prior research supporting the use of life story review in improving depression levels in cognitively intact community dwelling older adults.     

Features of problematic eating behaviors among community-dwelling older adults with dementia: Family caregivers' experience

This study aimed to explore family caregivers' experience of the problematic eating behaviors among community-dwelling older adults with dementia, and how these caregivers cope with these problems. An exploratory qualitative study using purposive sampling recruited family caregivers of community-dwelling older adults with dementia in southern Taiwan. In-depth interviews were carried out with a semi-structured interview guide. Data were saturated when the number of participants reached a certain number. The following three features were derived from the content analysis: fundamental deviations of eating behaviors, expressing needs through eating behaviors, and loss of eating ability. The results also show that caregivers often derived their own ways of coping with the problems they faced, and tended to have negative attitudes and behaviors with regard to coping with the demands of older adults with dementia. The findings of this study can provide valuable information to family caregivers with regard to the problematic eating behaviors of older adults with dementia, so that early recognition and understanding of such behaviors facilitate appropriate responses, thus reducing the burden shouldered by caregivers.     

Interventions to improve communication between people with dementia and nursing staff during daily nursing care: A systematic review

BackgroundTo provide adequate nursing care it is important for nursing staff to communicate effectively with people with dementia. Due to their limited communication skills, people with dementia have difficulties in understanding communication and expressing themselves verbally. Nursing staff members often report communication difficulties with people with dementia, which emphasises the urgent need for interventions to improve their communication with people in this specific target group.ObjectivesTo provide an up-to-date overview of communication interventions that are applicable during daily nursing care activities, irrespective of care setting, and to describe the effects on communication outcomes in people with dementia and nursing staff.DesignSystematic literature reviewData sourcesThe Cochrane Library, CINAHL, PsycINFO, and Pubmed databases were searched for all articles published until the 23rd of February 2016.Review methodsPapers were included, if: (1) interventions focused on communication between nursing staff and people with dementia and were applicable during daily nursing care; (2) studies were (randomised) controlled trials; (3) papers were written in English, Dutch, or German. Data were extracted on content and communication outcomes of interventions, and on methodological quality of the studies. The data extraction form and methodological quality checklist were based on the Method Guidelines for Systematic Reviews for the Cochrane Back Review Group.ResultsSix studies on communication interventions were included. All of the studies incorporated a communication skills training for nursing staff with a broad range in frequency, duration and content. In addition, there was wide variation in the communication outcome measures used. Four studies measured non-verbal communication, all found positive effects on at least some of the communication outcomes. Four studies measured verbal communication, of which three found positive effects on at least one of the measured outcomes. Methodological quality assessment demonstrated a high risk of bias in five of the six studies.ConclusionsFew studies have been identified with wide variation in interventions and outcome measures. In addition, the methodological shortcomings make it difficult, to draw conclusions about the effectiveness. More research is needed to develop and evaluate communication interventions. Additionally, it is useful to reach consensus on defining and measuring communication.     

Motivational interviewing for older adults in primary care: A systematic review

Chronic disease is now the leading cause of death and disability in United States. Many chronic illnesses experienced by older adults can be prevented or managed through behavior change, making patient counseling an essential component of disease prevention and management. Motivational Interviewing (MI), a type of conversational method, has been effective in eliciting health behavior changes in people in a variety of settings and may also be a useful tool to help older adults change. This review of the literature analyzes current research and describes potential biases of MI interventions that have been conducted in primary care settings with older adults. MI shows promise as a technique to elicit health behavior change among older adults. However, further study with this population is needed to evaluate efficacy of MI interventions in primary care settings.     

The association of eating performance and environmental stimulation among older adults with dementia in nursing homes: A secondary analysis

BackgroundNursing home residents with dementia experience increased risk for compromised eating performance due to intrapersonal, interpersonal, and environmental factors. Environmental stimulation is physical, social, and/or sensory stimulation present in the environment that can potentially trigger individuals’ emotion or motivate physical reactions. Beyond the personal factors, there is a lack of evidence on how environmental stimulation influences individuals’ eating performance at mealtimes.ObjectivesThis study examined the association between environmental stimulation and eating performance among nursing home residents with dementia.DesignThis study was a secondary analysis using baseline videos selected from a communication intervention study, where videos were recorded to capture staff-resident interactions during care activities for nursing home residents with dementia. Videos were included in this study only if residents demonstrated eating activities at mealtimes.Sample and settingA total of 36 videos were selected (mean length = 4 min). The sample included 15 residents with dementia (mean age = 86), and 19 certified nursing assistants (mean age = 36) in 8 nursing homes.MethodsThe dependent variable was eating performance as measured by the Level of Eating Independence scale (range: 15–36, with higher scores indicating better eating performance). The independent variables were characteristics of environmental stimulation measured by the Person-Environment Apathy Rating-Environment subscale (stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback). Each characteristic was rated on a 1–4 scale with higher scores indicating more desirable environmental stimulation. Multilevel models were used to examine the association between eating performance and environmental stimulation, adjusting for resident characteristics (i.e., age, gender, dementia stage, function, comorbidity, psychoactive medication use) and nesting effects of residents and staff.ResultsResident participants demonstrated moderate levels of eating performance (M = 27.08, SD = 5.16). Eating performance was significantly lower among older residents, those with more advanced dementia, and higher comorbidity. After controlling for resident characteristics, eating performance was significantly associated with stimulation specificity (how the stimulation is delivered and tailored to the resident), and was not associated with other environmental stimulation characteristics. For each 1 point increase in stimulation specificity, eating performance increased by 8.78 points (95% CI=0.59, 16.97).ConclusionsEnvironmental stimulation that is personally tailored to a resident’ needs and preferences and directly offered to a resident contributed to better eating performance among residents with dementia. The findings will direct future development and implementation of person-directed mealtime care programs and dining environment arrangements for residents with dementia in nursing homes.     

Effect of Baduanjin exercise on the cognitive function of middle-aged and older adults: A systematic review and meta-analysis

BackgroundAge-related cognitive decline is a pervasive problem in the ageing population. Baduanjin training is a mind-body exercise with the characteristics of traditional Chinese medicine, and increasing numbers of studies have reported its usefulness in modulating the cognitive performance of various populations. However, no systematic review has evaluated the effect of Baduanjin training on cognition in middle-aged and older adults.ObjectiveTo systematically evaluate the effects of Baduanjin on the global cognitive function and specific cognitive domains of middle-aged and elderly people.MethodsFour literature databases (PubMed, Cochrane library, EMBASE, and Web of Science) and four Chinese databases (Wanfang, China National Knowledge Infrastructure, Chinese Science and Technology Periodical and China Biology Medicine) were searched from inception through May 2020. Randomized controlled trials (RCTs) examining the effect of Baduanjin exercise on the cognitive function of middle-aged and elderly people were included. Assessment of the risk of bias for the included studies and data synthesis were conducted using the software Review Manager 5.3 based on the methods given in the Cochrane Handbook.ResultsBaduanjin training showed significant benefit for global cognitive function and parts of specific domains of cognition, including general memory and its sub-domains (i.e., immediate memory and delayed memory), executive function, and processing speed, but no significant difference was found in attention function, visual-spatial ability or long-term memory (a sub-domain of memory). No related adverse events were reported in the included studies.ConclusionsThe findings of this review suggest that Baduanjin is safe and effective in enhancing global cognitive function and memory in middle-aged and older adults and potentially beneficial to parts of the other specific domains of cognition, including executive function and processing speed. However, additional trials with larger sample sizes and a more rigorous design are needed before more definitive conclusions can be drawn.     

The effectiveness of non-pharmacological interventions in older adults with depressive disorders: A systematic review

BackgroundIt is widely acknowledged that mental health disorders are common in older adults and that depression is one of the most serious threats to the mental health of older adults. Although best practice guidelines point out that moderate to severe depression should be approached with pharmacotherapy together with complementary therapies, the use of antidepressant drugs in older adults has various disadvantages, such as long response time, side effects, potential risk of dependency and tolerance, poor compliance rates and high probability of drug interactions. In addition, qualitative studies of depressed people with a chronic illness have indicated that both patients and healthcare professionals prefer a psychosocial treatment for depression over a pharmacological one.ObjectiveThis review aimed to identify and synthesize the best available evidence related to the effectiveness of non-pharmacological interventions for older adults with depressive disorders.DesignSystematic review of studies with any experimental design considering non-pharmacological interventions for older adults with depressive disorders.Data sourcesAn initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies, from January 2000 to March 2012, of major healthcare-related electronic databases. Studies in English, Spanish and Portuguese were included in the review.Review methodsThis review considered studies that included adult patients, aged over 65 years with any type of depressive disorder, regardless of comorbidities and any previous treatments, but excluded those with manic or psychotic episodes/symptoms. All studies that met the inclusion criteria were assessed for methodological quality by two independent reviewers using a standardized critical appraisal checklist for randomized and quasi-randomized controlled studies from the Joanna Briggs Institute. Data extraction was also conducted by two independent reviewers based on the Joanna Briggs Institute data extraction form for experimental studies.ResultsTwenty-three studies met the inclusion criteria. Of those, seventeen were excluded after critical appraisal of methodological quality and six were included in this review. These studies included 520 participants and described cognitive behavior therapy, competitive memory training, reminiscence group therapy, problem-adaptation therapy, and problem-solving therapy in home care. Evidence suggests that all these interventions reduce depressive symptoms.ConclusionsAccording to evidence, non-pharmacological interventions had positive effects on improving patients’ depression and may be useful in practice. However, due to the diversity of interventions and the low number of studies per intervention included in this systematic review, evidence is not strong enough to produce a best practice guideline.     

Evidence moderately supports effectiveness of interventions targeting mealtime difficulties in older adults with dementia

This review provides a summary and appraisal commentary on the treatment review by Liu, W., Cheon, J., & Thomas, S. A. (2014). Interventions on mealtime difficulties in older adults with dementia: A systemaic review. International Journal of Nursing Studies, 51, 14–27.

Source of funding and declaration of interest: Declared no funding and no conflicts of interest.     

Associations among hearing loss,hospitalization, readmission and mortality in older adults: A systematic review

ObjectiveOlder adults with hearing loss face many challenges impacting health outcomes. The objective of this review was to evaluate current evidence for associations among hearing loss, hospitalizations, readmissions and mortality in older adults living with hearing loss.MethodsA systematic search, of PubMed, CINAHL and Embase was performed in October 2018. Studies that were included consisted of populations aged 50 and older, publications after 2004, clearly defined hearing loss measurements, and non-aggregated, appropriate outcome variables. We excluded deafness, specified hearing losses, and cochlear implant users.ResultsFifteen mortality studies, four hospitalization studies, and one readmission study were identified. After adjustments, three mortality, three hospitalization, and the one readmission study found significant associations.DiscussionHearing loss was associated with an increased risk of hospitalizations, readmission and mortality. However, there is insufficient evidence to support that hearing loss is independently associated to increased risk of these outcomes.     

Effects of yoga-based interventions on cognitive function in healthy older adults: A systematic review of randomized controlled trials

BackgroundThe world's elderly population is growing. Physical activity has positive effects on health and cognition, but is decreasing among the elderly. Interest in yoga-based exercises has increased in this population, especially as an intervention targeting balance, flexibility, strength, and well-being. Recent interest has arisen regarding yoga’s potential benefits for cognition.ObjectiveTo systematically review evidence from randomized controlled trials (RCTs) examining the effects of yoga-based interventions on cognitive functioning in healthy adults aged ≥60. A secondary aim was to describe intervention characteristics and, where possible, the extent to which these influenced study outcomes.MethodThe review was conducted in accordance with PRISMA guidelines. Searches were performed from inception to June 2020 using the following electronic databases: (1) PubMed (NLM); (2) Embase (Elsevier); (3) Cochrane Central (Wiley); (4) PsycINFO (EBSCOhost); and (5) Cinahl (EbscoHost). Inclusion criteria: RCTs of yoga-based interventions assessing cognition in healthy adults ≥60 years. Risk of bias was assessed using the revised Cochrane risk of bias tool.ResultsA total of 1466 records were initially identified; six studies (5 unique trials) were included in the review. Four of the six articles reported significant positive effects of yoga-based interventions on cognition, including gross memory functioning and executive functions. Intervention characteristics and assessment methods varied between studies, with a high overall risk of bias in all studies.ConclusionYoga-based interventions are associated with improvements in cognition in healthy older adults. Adequately powered RCTs with robust study designs and long-term follow-ups are required. Future studies should explicitly report the intervention characteristics associated with changes in cognitive function.     

Combined Tai Chi and cognitive interventions for older adults with or without cognitive impairment: A meta-analysis and systematic review

Background and purposeEvidence from the field of cognitive interventions indicates that nonpharmaceutical interventions seem more promising in enhancing cognition. The number of clinical trials that examine the cognitive benefits of combined physical exercise with cognitive intervention on older adults has recently increased. Tai Chi (TC) has been recommended as an effective and safe exercise for older adults aged 60 and over. However, there is a lack of conclusion about whether combined TC with cognitive interventions can show more benefits than a single intervention for older adults. Thus, this review aimed to evaluate the effects of combined TC and cognitive interventions on older adults.MethodsPubMed, Embase, PsycINFO, and Web of Science were searched for English peer-reviewed papers from inception until November 12, 2021. Data were extracted by two independent reviewers.ResultsA total of 1524 records were generated and nine studies were included. The pooled results showed that combined TC and cognitive interventions showed significantly large gains on memory [standardised mean difference (SMD) = 0.87, 95% confidence interval (CI): (0.01, 1.74), P 0.05], moderate gains on cognition [SMD = 0.74, 95% CI:(0.19, 1.29), P 0.05], and small size effects on balance. No statistically significant difference was found in executive function, depression, risk of falls, or well-being.ConclusionCombined TC and cognitive interventions have positive effects on improving cognition and balance in older adults, but their superiority over the single intervention, as well as their additional effects on the physical and psychological function, are required further investigation.