Contemplating, Caring, Coping, Conversing: A Model for Promoting Mental Wellness in Later Life

This article is based on the premise that mental wellness for older adults can be promoted through communication and presents a model drawing on the constructs of contemplating, caring, coping, and conversing. The importance of interpersonal communication processes in the care of older adults and some barriers to communication and mental wellness are briefly reviewed. This article challenges nurses to develop awareness of their own caregiving styles and communication processes, and to assist others (e.g., family caregivers, care receivers) to communicate and interact more effectively to advance mental wellness for older adults. Populations throughout the world are continuing to grow as life expectancy increases. The aging of the population has driven both governments and health professionals in many countries to recognize the need for care practices focusing on maintaining and promoting the health of older adults. Although cure and healing measures extend age, there is no cure for aging. However, various components of health, such as quality of life, personal growth, and healthy relationships, can and should be promoted and maintained throughout the aging process. These components of health are largely subjective and reflect an individual's mental wellness or mental health. In this article, mental wellness is understood to be a state of mind promoting a balanced, active, and social life through effective adjustment to life's physical, social, emotional, and spiritual challenges. Driven by the premise that mental wellness for older adults can be promoted through communication, this article presents four dimensions of a model for a communication style promoting mental wellness in later life. The dimensions of the model comprise the constructs contemplating, caring, coping, and conversing. Brief dialogues are used to highlight the constructs and how they inform communication that advances mental wellness for older adults. Before examining the four constructs in terms of their relationship to communication, the importance of interpersonal communication processes in elder care and some current barriers are briefly reviewed

Is There Extra Cost of Institutional Care for MS Patients?

Throughout life, patients with multiple sclerosis (MS) require increasing levels of support, rehabilitative services, and eventual skilled nursing facility (SNF) care. There are concerns that access to SNF care for MS patients is limited because of perceived higher costs of their care. This study compares costs of caring for an MS patient versus those of a typical SNF patient. We merged SNF cost report data with the 2001-2006 Nursing Home Minimum Data Set (MDS) to calculate percentage of MS residents-days and facility case-mix indices (CMIs). We estimated the average facility daily cost using hybrid cost functions, adjusted for facility ownership, average facility wages, CMI-adjusted number of SNF days, and percentage of MS residents-days. We describe specific characteristics of SNF with high and low MS volumes and examine any sources of variation in cost. MS patients were no longer more costly than typical SNF patients. A greater proportion of MS patients had no significant effect on facility daily costs (P = 0.26). MS patients were more likely to receive care in government-owned facilities (OR = 1.904) located in the Western (OR = 2.133) and Midwestern (OR = 1.3) parts of the USA (P < 0.05). Cost of SNF care is not a likely explanation for the perceived access barriers that MS patients face

Long-term use of motion-based video games in care home settings

Recent research suggests that motion-based video games have the potential to provide both mental and physical stimulation for older adults in residential care. However, little research has explored the practical challenges and opportunities that arise from integrating these games within existing schedules of activities in these contexts. In our work, we report on a qualitative enquiry that was conducted over a three month period at two long-term care facilities. Findings suggest that older adults enjoyed playing video games, and that games can be a valuable means of re-introducing challenge in late life, but that the impact of age-related changes and impairment can influence people’s ability to engage with games in a group setting. We outline core challenges in the design for care context and discuss implications of our work regarding the suitability of games as a self-directed leisure activity

Models for providing improved care in residential care homes: a thematic literature review

This Annotated Bibliography is one output from a review of the available research evidence to support improved care in residential care homes as the needs of older people intensify. Key findings The review identified extremely little published evidence on residential care homes; the research base is almost exclusively related to provision of care in nursing homes. Much of this research is from the US or other non-UK sources. Although it could be argued that some findings are generalisable to the UK residential care context, a systematic process is required to identify which. The literature often makes no distinction between nursing and residential homes; use of generic terms such as ‘care home’ should be avoided. There is considerable international debate in the quality improvement literature about the relationship between quality of care and quality of life in nursing and residential homes. Measures of social care, as well as clinical care, are needed. The centrality of the resident’s voice in measuring quality of life must be recognised. Ethnic minority residents are almost entirely absent from the quality improvement literature. Some clinical areas, internationally identified as key in terms of quality e.g. palliative care, are absent in the general nursing and residential home quality improvement literature. Others such as mental health (dementia and depression), diabetes, and nutrition are present but not fully integrated. Considerable evidence points to a need for better management of medication in nursing homes. Pharmacist medication reviews have shown a positive effect in nursing homes. It is unclear how this evidence might relate to residential care. There is evidence that medical cover for nursing and residential care home residents is suboptimal. Care could be restructured to give a greater scope for proactive and preventive interventions. General practitioners' workload in care homes may be considered against quality-of-care measures. There is US literature on the relationship between nurse staffing and nursing care home quality, with quality measured through clinical-based outcomes for residents and organisational outcomes. Conclusions are difficult to draw however due to inconsistencies in the evidencebase. Hospital admission and early discharge to nursing homes research may not be generalisable to residential care. The quality of inter-institutional transfers and ensuring patient safety across settings is important. To date research has not considered transfer from residential to nursing home care. The literature on district nurse and therapist roles in care homes includes very little research on residential care. Partnership working between district nurses and care home staff appears largely to occur by default at present. There is even less research evidence on therapist input to care homes. Set against the context outlined above, the international literature provides evidence of a number of approaches to care improvement, primarily in nursing homes. These include little discussion of cost-effectiveness other than in telecare. Research is needed in the UK on care improvement in residential homes

Like Disney For Adults: Life In Freedom Village

With an increasingly aging population, American society needs to more effectively address living options for the aging population in the present and future. Older adults have unique needs due to their age, physical and mental condition, varying needs for medical and health care and assistance with their daily activities. Freedom Village is an example of a very successful continuing care retirement community (CCRC) in Holland, Michigan. Using a case study approach and structured questions to ask two residents of Freedom Village, her aunt and uncle, over a period of several months, the author learned that they have lived very happily at Freedom Village since 2009. The community provides them and other residents with a safe environment; high quality medical care options that are flexible enough to change as their needs change; opportunities for social contact with both their peers and with younger people; and caregivers who are trained in and understand the unique needs of an older population. One disadvantage of Freedom Village, however, is its steep cost, both to buy in and to pay the monthly maintenance fees. The author concludes that care for older adults should be the responsibility of both their families and the state/federal governments, through policies and legislation that encourage family members to care for their older parents. This will ensure that livable communities such as Freedom Village will be as accessible to older adults with limited resources as they are to those with more extensive means

The Links Between Motivational Techniques, Successful Physical Therapists, and Successful Rehab Clinics

There is a strong positive correlation between a successful physical therapist (PT), their clinic, and the motivational techniques used during therapy. The PT should be prepared to sit down with each patient and set short- and long-term goals to help them accomplish what they desire through therapy. Effective communication skills, practical skills and technique, individualized care, and organizational and environmental factors are the four major aspects that define patient-therapist relationships. Patient adherence to their home exercise program (HEP) is vital to a successful rehabilitation, and therefore the PT’s goal should be to help the patient understand the importance of the prescribed protocol. To do this, the PT should be able to creatively find ways to relate to each patient, regardless of their age, gender or demographic. As part of this thesis, a research study was also conducted to investigate best motivational practices in PT. Data were collected through a ten-question survey distributed at a well-known, successful clinic to identify what is the most important to patients during the rehabilitation process. One of the questions, “rate how well the physical therapist’s personality meshes with the patient’s” had the highest rating, which supported the prediction that in rehabilitation it is most important that the PT be able to relate to the patient on a personal level. Based on the results of the survey, itwas concluded that the most important motivational factor to patients was the personality of the PT. Therefore, for a clinic to be successful, it is recommended to hire staff that are not only well educated but have a warm and caring personality

Conversational affective social robots for ageing and dementia support

Socially assistive robots (SAR) hold significant potential to assist older adults and people with dementia in human engagement and clinical contexts by supporting mental health and independence at home. While SAR research has recently experienced prolific growth, long-term trust, clinical translation and patient benefit remain immature. Affective human-robot interactions are unresolved and the deployment of robots with conversational abilities is fundamental for robustness and humanrobot engagement. In this paper, we review the state of the art within the past two decades, design trends, and current applications of conversational affective SAR for ageing and dementia support. A horizon scanning of AI voice technology for healthcare, including ubiquitous smart speakers, is further introduced to address current gaps inhibiting home use. We discuss the role of user-centred approaches in the design of voice systems, including the capacity to handle communication breakdowns for effective use by target populations. We summarise the state of development in interactions using speech and natural language processing, which forms a baseline for longitudinal health monitoring and cognitive assessment. Drawing from this foundation, we identify open challenges and propose future directions to advance conversational affective social robots for: 1) user engagement, 2) deployment in real-world settings, and 3) clinical translation

Navigating Long-Term Care

Americans over age 65 constitute a larger percentage of the population each year: from 14% in 2010 (40 million elderly) to possibly 20% in 2030 (70 million elderly). In 2015, an estimated 66 million people provided care to the ill, disabled, and elderly in the United States. In 2000, according to the Centers for Disease Control and Prevention (CDC), 15 million Americans used some form of long-term care: adult day care, home health, nursing home, or hospice. In all, 13% of people over 85 years old, compared with 1% of those ages 65 to 74, live in nursing homes in the United States. Transitions of care, among these various levels of care, are common: Nursing home to hospital transfer, one of the best-studied transitions, occurs in more than 25% of nursing home residents per year. This article follows one patient through several levels of care

Patient Compliance-Gaining: A Look At Care Facility vs. Home Health

The patient compliance-gaining strategies employed by health care providers in the care facility and home health environments were investigated. Each participant completed a two-page, open-ended survey. A content analysis, and more specifically a thematic analysis of the research, allowed for similarities and differences between the two settings to be compared to current literature. Results indicated that participants used similar strategies to those suggested by researchers in the field. The results showed that strategies applied by health care providers in this particular study are effective for gaining patient compliance