Effects of Mindfulness-Based Elder Care (MBEC) on symptoms of depression and anxiety and spiritual well-being of institutionalized seniors with disabilities: a randomized controlled trial.

BACKGROUND: Despite the need to incorporate seniors from various settings into mindfulness-based empirical research, issues of geriatric frailties and non-compliance remain. This study aimed to evaluate the effects of a mindfulness-based elder care (MBEC) program on mental health and spiritual well-being among seniors with disabilities in long-term care residential settings. METHODS: This single-blind, randomized controlled trial (RCT) randomly assigned seventy-seven participants into an MBEC group or control group of an eight-week MBEC program. Participants were assessed every four weeks at baseline (T0), mid-intervention (T1), post-intervention (T2) and follow-up (T3) using the Geriatric Depression Scale Short Form (GDS-SF), the State-Trait Anxiety Inventory (STAI) and the Spiritual Well-Being Scale (SWBS), respectively. RESULTS: Linear mixed model (LMM) showed that MBEC participants' mental health improved significantly after completing the intervention; compared with controls, the MBEC group exhibited significantly lower anxiety (state-anxiety at T2; trait-anxiety at T2 and T3) and fewer depressive symptoms. Spiritual well-being was also significantly enhanced compared to that in the control group. CONCLUSIONS: MBEC has positive effects on both mental health and spiritual well-being outcomes among seniors with disabilities. In long-term care facilities, seniors with abilities have the potential to adhere to and engage in activities of a mindfulness-based intervention. This low risk, easily accessible, and effective 8-week program is recommended to be integrated into regular long-term care institutional routines. TRIAL REGISTRATION: This study was registered with Clinical Trial Registry (ClinicalTrials.gov - U.S. National Library of Medicine #NCT05123261. Retrospectively registered on 07/04/2021.). The CONSORT 2010 guidelines were used in this study for properly reporting how the randomized trial was conducted.

Effects of Aroma Foot Massage on Sleep Quality and Constipation Relief among the Older Adults Living in Residential Nursing Facilities.

This study focused on the effects of aroma foot massage on sleep quality and constipation relief among older adult residents in nursing facilities. This research used a non-equivalent control group and a quasi-experimental design. The participants included 40 older adults aged ≥70 years residing in two nursing facilities in Seoul City. The aroma foot massage nursing intervention consisted of a preparation stage using jojoba carrier (aroma recipe) oil and lavender oil, an aroma foot massage stage, and a finishing stage. Sleep quality scores after the experiment increased by 3.72 at post-test (M = 38.44) compared to pre-test (M = 34.72), which confirmed that sleep quality improved significantly following intervention in the experimental group as compared to the control group (F = 14.45, p = 0.001). Furthermore, the frequency of defecation in the experimental group was significantly higher than that in the control group (Z = −3.93, p < 0.001). Similarly, the constipation assessment scores decreased at post-test significantly by 2.39 in the experimental group as compared to the control group (F = 17.87, p < 0.001). These results confirm that aroma foot massage is an effective nursing intervention for alleviating constipation symptoms and improving sleep quality. Therefore, we recommend that aroma foot massage be used as a complementary intervention in combination with drug-based treatment to improve sleep quality and relieve the constipation symptoms experienced by older adults living in nursing facilities.

Disparities in Oral Nutritional Supplement Usage and Dispensing Patterns across Primary Care in Ireland: ONSPres Project.

When treating malnutrition, oral nutritional supplements (ONSs) are advised when optimising the diet is insufficient; however, ONS usage and user characteristics have not been previously analysed. A retrospective secondary analysis was performed on dispensed pharmacy claim data for 14,282 anonymised adult patients in primary care in Ireland in 2018. Patient sex, age, residential status, ONS volume (units) and ONS cost (EUR) were analysed. The categories of 'Moderate' (<75th centile), 'High' (75th-89th centile) and 'Very High' ONS users (≥90th centile) were created. The analyses among groups utilised t-tests, Mann-Whitney U tests and chi-squared tests. This cohort was 58.2% female, median age was 76 years, with 18.7% in residential care. The most frequently dispensed ONS type was very-high-energy sip feeds (45% of cohort). Younger males were dispensed more ONSs than females (<65 years: median units, 136 vs. 90; p < 0.01). Patients living independently were dispensed half the volume of those in residential care (112 vs. 240 units; p < 0.01). 'Moderate' ONS users were dispensed a yearly median of 84 ONS units (median cost, EUR 153), 'High' users were dispensed 420 units (EUR 806) and 'Very High' users 892 yearly units (EUR 2402; p < 0.01). Further analyses should focus on elucidating the reasons for high ONS usage in residential care patients and younger males.

Seeking and maintaining connections: A grounded theory study of maintaining spirituality in residential aged care facilities.

BACKGROUND: Moving to a residential aged care facility involves living far from family and a familiar environment, and leaving behind the social support system of relatives, friends, and society. The pressure to find and develop new and meaningful connections in a residential aged care facility can be significant for older adults. OBJECTIVE: To provide a theoretical explanation of how older adults seek and maintain connections in a residential aged care facility. METHODS: A grounded theory study was conducted. A total of 17 residents were recruited from two Nepalese residential aged care facilities using theoretical sampling. Face to face in-depth, semi-structured interviews and observation within interviews were conducted. Data analysis included the process of open, axial, selective coding, and constant comparative analysis as per Corbin and Strauss' variant of grounded theory. RESULTS: This study identified that the process of seeking connections in a residential aged care facility was forward-moving, and involved "identifying sources," "developing connections," and "appraising responses." By seeking connections, residents built new connections. Similarly, the study found that maintaining connections was a continuous process of "sustaining connections with co-residents," "preserving connections with nurses/caregivers," and "continuing connections with inner-self and higher being/s." Maintaining connections led residents to balance shifting connections. Furthermore, it was found that the process of seeking and maintaining connections was conditional on facility arrangement i.e. the way residents were placed, rules, regulations, co-residents' language, gender, religious affiliation, attitudes, the attitudes and practices of nurses/caregivers, decreasing physical abilities of residents, increasing illness of residents, illness or death of co-residents, and retirement or resignation of nurses/caregivers. CONCLUSION: The current study provides unique insights into the process of seeking and maintaining connections in a residential aged care facility. Facility arrangement, rules, regulations, and caregiving practices should resonate with residents' socio-cultural expectations and spiritual belief system to support their process of seeking and maintaining connections. IMPLICATIONS FOR PRACTICE: The findings can be beneficial for managers, nurses, caregivers, and spiritual advisors in developing interventions that promote the development of meaningful connections in a residential aged care facility.

Factors associated with the appropriate use of ultra-broad spectrum antibiotics, meropenem, for suspected healthcare-associated pneumonia.

ABSTRACT: Pneumonia is a common disease-causing hospitalization. When a healthcare-associated infection is suspected, antibiotics that provide coverage for multi-drug resistant (MDR) or extended-spectrum beta-lactamase (ESBL) bacteria are frequently prescribed. Limited data is available for guidance on using meropenem as a first-line empiric antimicrobial in hospitalized patients with risk factors for MDR/ESBL bacterial infections.This was a single-center, retrospective study designed and conducted to identify factors associated with positive cultures for MDR/ESBL pathogens in hospitalized patients with suspected healthcare-associated pneumonia.Of the 246 patients, 103 patients (41%) received meropenem. Among patients prescribed meropenem, MDR/ESBL pathogens were detected in only 20 patients (13%). Patients admitted from a skilled nursing facility/long-term acute care (SNF/LTAC) or with a history of a positive culture for MDR/ESBL pathogens were significantly associated with positive cultures of MDR/ESBL pathogens during the hospitalization (odds ratio [95% confidence intervals], 31.40 [5.20-189.6] in SNF/LTAC and 18.50 [2.98-115.1] in history of culture-positive MDR/ESBL pathogen). There was no significant difference in mortality between the 3 antibiotic groups.Admission from a SNF/LTAC or having a history of cultures positive for MDR/ESBL pathogens were significantly associated with a positive culture for MDR/ESBL pathogens during the subsequent admission. We did not detect significant association between meropenem use as a first-line drug and morbidity and mortality for patients admitted to the hospital with suspected healthcare-associated pneumonia, and further prospective studies with larger sample size are needed to confirm our findings.

Reintegration interventions for CPTSD: a systematic review.

Background: Clinical guidelines recommend a phase-based approach to treatment for complex post-traumatic stress disorder (CPTSD), yet little is known about what interventions are being offered and which may be effective in the final 'reintegration' phase. Objective: To systematically review literature on reintegration interventions for CPTSD, describing the nature and effectiveness of interventions. Method: We searched four electronic databases (Medline, PsycINFO, Embase, and PTSDpubs) for interventions aiming to facilitate reintegration for participants with probable CPTSD. We had two aims: firstly, to describe the interventions and secondly, to describe their effectiveness as measured through measures of reintegration, PTSD and/or disturbances in self-organization (DSO), or qualitative data describing changes experienced. Results are presented using narrative synthesis. Results: Fifteen studies met our inclusion criteria. Interventions included yoga, exercise, use of service dogs, residential treatment, education, self-defence and patient research involvement. Overall study quality was low, as assessed by critical appraisal tools. Of the six studies including a control group, two reported a statistically significant improvement in the measure of reintegration between the intervention and control group, four studies reported a statistically significant difference in the measure of PTSD symptoms, but none reported any significant differences between intervention and control groups in DSO. Of all eight quantitative studies, three reported a statistically significant difference in the reintegration measure pre- to post-intervention for the intervention group, five a statistically significant improvement in the measure of PTSD symptoms, and three a significant difference in the DSO measure. From eight studies reporting qualitative date we synthesized themes into eight categories, within which facilitation of connection with others was the most commonly reported benefit. Conclusions: The interventions outlined may facilitate reintegration, however, research in this area is still in its infancy and quality research is lacking. Further research is needed to establish whether reintegration interventions enhance treatment for CPTSD.

Antecedentes: Las guías clínicas recomiendan un enfoque basado en fases para el tratamiento del trastorno de estrés postraumático complejo (TEPTC), aunque se sabe poco acerca de las intervenciones que se ofrecen y cuáles pueden ser efectivas en la fase final de 'reintegración'.Objetivo: Revisar la literatura en forma sistemática acerca de intervenciones de reintegración para el TEPTC, describiendo la naturaleza y efectividad de las intervenciones.Método: Para las intervenciones cuyo objetivo era facilitar la reintegración de los participantes con probable TEPTC, buscamos en cuatro bases de datos electrónicas (Medline, PsycINFO, Embase, y PTSDpubs). Teníamos dos objetivos: en primer lugar, describir las intervenciones y, en segundo lugar, describir su efectividad medida a través de mediciones de reintegración, TEPT y/o alteraciones en la auto-organización (DSO en sus siglas en ingles), o datos cualitativos que describieran los cambios experimentados. Los resultados se presentan mediante síntesis narrativa.Resultados: Quince estudios reunieron nuestros criterios de inclusión, La intervenciones incluían yoga, ejercicio, uso de perros de servicio, tratamiento residencial, educación, autodefensa y la implicación del paciente en la investigación. La calidad del estudio en general fue baja, según la evaluación de las herramientas de evaluación críticas. De los seis estudios que incluyeron un grupo control, dos reportaron una mejoría estadísticamente significativa en la medición de la reintegración entre la intervención y el grupo control, cuatro estudios reportaron una diferencia estadísticamente significativa en la medición de los síntomas de TEPT, pero ninguno reportó alguna diferencia significativa en los síntomas DSO entre los grupos de intervención y control. De los ocho estudios cuantitativos, tres reportaron una diferencia estadísticamente significativa en la medición de la reintegración pre y post intervención para el grupo con intervención, cinco una mejoría estadísticamente significativa en la medición de los síntomas de TEPT, y tres una diferencia significativa en la medición de los síntomas DSO. De los ocho estudios que reportaron datos cualitativos los sintetizamos por temas en ocho categorías, dentro de las cuales la facilitación de la conexión con otros fue el beneficio más comúnmente reportado.Conclusiones: Las intervenciones descritas pueden facilitar la reintegración, sin embargo, la investigación en esta área aún está dando sus primeros pasos y se carece investigación de calidad. Se necesita más investigación para establecer si las intervenciones de reintegración mejoran el tratamiento para el TEPTC.

Activities outside of the care setting for people with dementia: a systematic review.

OBJECTIVES: To summarise the evidence from interventions investigating the effects of out of care setting activities on people with dementia living in residential aged care. DESIGN: A systematic review. METHODS: A systematic search of electronic databases (PubMed, PsycINFO, Scopus, Web of Science and the Cochrane Library) was performed to identify intervention trials published from journal inception to January 2020. Controlled trials, or quasi-experimental trials, which measured pre-intervention, post-intervention or during-intervention outcomes, where the participants were required to leave the care setting to participate in an intervention, were eligible for inclusion. Quality appraisal of the studies was performed following the Cochrane Collaboration's Risk of Bias or Newcastle-Ottawa Scale tools. RESULTS: Of the 4155 articles screened, 11 articles met the inclusion criteria from 9 different studies. The number of participants in the studies ranged from 6 to 70 people living with dementia and lasted for 3 weeks up to 5 months. The interventions were aquatic exercise, wheelchair cycling, art gallery discussion groups, an intergenerational mentorship programme, horse riding, walking and outdoor gardening. Overall, the studies indicated preliminary evidence of psychological (n=7), physical (n=4) and physiological (n=1) benefits, and all interventions were feasible to conduct away from the aged care facilities. However, the low number of participants in the included studies (n=177), the absence of a control group in all but three studies, and potential for selection bias, limits the generalisability of the findings. CONCLUSIONS: Activities outside of the residential aged care setting have the potential to be effective at providing a range of benefits for people living with dementia. Higher quality studies are required to encourage care providers to implement these type of activities in dementia care settings. PROSPERO REGISTRATION NUMBER: CRD42020166518.

Increasing the uptake of vitamin D supplement use in Australian residential aged care facilities: results from the vitamin D implementation (ViDAus) study.

BACKGROUND: Adequate (≥800 IU/day) vitamin D supplement use in Australian residential aged care facilities (RACFs) is variable and non-optimal. The vitamin D implementation (ViDAus) study aimed to employ a range of strategies to support the uptake of this best practice in participating facilities. The aim of this paper is to report on facility level prevalence outcomes and factors associated with vitamin D supplement use. METHODS: This trial followed a stepped wedge cluster, non-randomised design with 41 individual facilities serving as clusters pragmatically allocated into two wedges that commenced the intervention six months apart. This multifaceted, interdisciplinary knowledge translation intervention was led by a project officer, who worked with nominated champions at participating facilities to provide education and undertake quality improvement (QI) planning. Local barriers and responsive strategies were identified to engage stakeholders and promote widespread uptake of vitamin D supplement use. RESULTS: This study found no significant difference in the change of vitamin D supplement use between the intervention (17 facilities with approx. 1500 residents) and control group (24 facilities with approx. 1900 residents) at six months (difference in prevalence change between groups was 1.10, 95% CI - 3.8 to 6.0, p = 0.6). The average overall facility change in adequate (≥800 IU/day) vitamin D supplement use over 12 months was 3.86% (95% CI 0.6 to 7.2, p = 0.02), which achieved a facility level average prevalence of 59.6%. The variation in uptake at 12 months ranged from 25 to 88% of residents at each facility. In terms of the types of strategies employed for implementation, there were no statistical differences between facilities that achieved a clinically meaningful improvement (≥10%) or a desired prevalence of vitamin D supplement use (80% of residents) compared to those that did not. CONCLUSIONS: This work confirms the complex nature of implementation of best practice in the RACF setting and indicates that more needs to be done to ensure best practice is translated into action. Whilst some strategies appeared to be associated with better outcomes, the statistical insignificance of these findings and the overall limited impact of the intervention suggests that the role of broader organisational and governmental support for implementation should be investigated further. TRIAL REGISTRATION: Retrospectively registered (ANZCTR ID: ACTRN12616000782437 ).

Complementary and alternative medicine (CAM) in Danish residential homes for people with severe mental illness: Use and perceived benefits of CAM in relation to recovery.

BACKGROUND AND AIM: Mental health services in Denmark offer various rehabilitative treatment interventions to people with severe mental illness. Complementary and Alternative Medicine (CAM) such as National Acupuncture Detoxification Association (NADA) ear acupuncture are used as rehabilitative interventions. We investigated the use of CAM in four psychiatric residential homes, and whether CAM supports residents' rehabilitation and personal recovery. METHODS: Residents in four selected residential homes participated in a questionnaire study, which elicited information on the use of CAM offered in a residential home setting. The study was conducted from February to November 2017. Recovery scores were assessed using the Mental Health Recovery Measure (MHRM). RESULTS: Of 131 eligible respondents, 68 (52%) participated. CAM was used by 84% of the residents. NADA ear acupuncture (38%) and music therapy (37%) were the most commonly used types of CAM. CONCLUSIONS: CAM is a commonly used rehabilitative intervention and more than 50% receiving treatment with CAM believed that it has supported their recovery process.

[The Effectiveness of a Mindfulness-Based Intervention in Reducing Relocation Anxiety and Promoting Adaptation in Older People With Diabetes].

BACKGROUND: Relocating from home to a long-term facility is frequently a stressful event for older persons with diabetes. Therefore, it is important that nurses have available an intervention program that effectively reduces relocation anxiety and promotes adaptation in this population. PURPOSE: To evaluate the effectiveness of a mindfulness-based intervention in reducing relocation anxiety and promoting adaptation in older persons with diabetes. METHODS: Four long-term care facilities in Kaohsiung City were selected as the study sites. Residents of these facilities who had diabetes and who had moved in within the previous year were recruited as participants using a simple random-sampling method. The experimental group (n = 34) received a 9-week mindfulness-based intervention and the control group (n = 32) received routine diabetes care and maintained their normal daily routine. Outcome measurements included a demographic datasheet, the Taiwanese version of the State Anxiety Inventory, and the individual mental factors subscale of the elderly adaptation problem scale. These measures were administered at baseline and upon completion of the intervention. RESULTS: Thirty participants in each group completed the study. The mean differences between the baseline and post-test scores in the experimental group for relocation anxiety (t = 5.15, p < .01) and adaptation (t = -5.57, p < .01) were both significant. Among the participants who tested positive for relocation anxiety at pretest (a mean score > 30.13; 83.3% of the participants), those in the experimental group reported a more significant decrease (p < .05) in relocation anxiety at posttest than their control group peers. Among the participants who tested as having poor adaptation pretest (a mean scores < 45.62; 71.7% of the participants), those in the experimental group reported a more significant improvement (p < .05) in adaptation at posttest than their control group peers. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results indicate that the 9-week intervention has the potential to help older people with diabetes improve their relocation anxiety and adaptation. This study may be used as a reference to improve emotional distress among residents of long-term care facilities.

Acupressure to improve sleep quality of older people in residential aged care: a randomised controlled trial protocol.

BACKGROUND: Sleep disturbance in older people is an important health issue that is associated with many other health problems. Effective interventions are required to address sleep problems in this group. Acupressure has been suggested as a potential therapeutic technique to improve sleep. The aim of this study is to evaluate the effects of an acupressure intervention on sleep quality, anxiety, depression, and quality of life among older persons in residential aged care facilities within an Australian context. METHODS/DESIGN: This is a randomised controlled trial with two parallel groups in a pre- and post-test study. Study participants will be older people living in residential aged care facilities. They will be assigned to intervention and control groups using computer-generated random numbers. The intervention group will receive 12-min acupressure three times per week for four consecutive weeks, applied on three acupoints: HT7, PC6, and SP6. The control group will receive only routine care. The primary outcome measure is sleep quality, and secondary outcomes include anxiety, depression, and quality of life. Data will be collected before the intervention, immediately after the end of the intervention, and 2 weeks after the intervention. DISCUSSION: This study targets a poorly met healthcare need of older people who are experiencing sleep disturbance and its negative consequences. To the researchers' knowledge, this is the first study evaluating acupressure in an Australian aged care context, using specific acupoints and a standardised acupressure protocol. If the results show positive outcomes, acupressure could be used to manage sleep disturbances for older people in the Australian context as well as in the global ageing population. This will contribute to reducing negative consequences of sleep disturbance and use of sleep medications. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12619000262101. Registered on 20 February 2019.

Effect of Chaplaincy Visits in an Elder Care Setting: A Pilot Analysis of Existing Data.

Religion is a consistent, positive predictor of health in older adults. Studies focused on religion and spirituality as a coping mechanism find significant positive effects on the lives of older adults. This study investigated how an older person's living situation influences his or her access to spiritual and religious resources and, consequently, his or her health. Utilizing existing data, this pilot project examined the relationship between visits from a chaplain and the mood, pain level, functional ability, and/or discharge status of elders residing in the rehabilitation unit of one long-term care facility. Samples of patients who did and did not have chaplaincy visits were matched based on their level of frailty. Analytic comparisons revealed no significantly different outcomes in terms of mood, pain level, functional ability, or discharge status for patients visited by a chaplain. The outcomes suggest future hypotheses and offer a model for outcomes-based chaplaincy research.

Does a High-Energy High-Protein Diet Reduce Unintentional Weight Loss in Residential Aged Care Residents?

Malnutrition and unintentional weight loss are known to occur in residential aged care facilities (RACFs). The use of oral nutritional supplements (ONS) and high-energy high-protein (HEHP) diets are two foodservice strategies that may be implemented in efforts to reduce unintentional weight loss in RACFs. This observational study aimed to determine whether incorporation of a structured high-energy high-protein diet (sHEHP) into the standard menu could reduce unintentional weight loss in RACF residents. RACFs in this study were facilities that provide long-term care to older adult residents. Weight change, body mass index and subjective global assessment scores of participants were measured at baseline and at six months across five RACFs receiving usual care with ONS or a sHEHP diet. Groups were different at baseline, with a high prevalence of severe malnutrition observed in the ONS group. Over the six-month period, there was a small but statistically significant difference in weight change within the groups: -1.64 ± 3.62 kg, ONS group; 0.56 ± 2.76 kg, sHEHP group, P = 0.0004. Both approaches investigated are feasible, however, future research using high-quality methods is needed to determine the most effective approach to deliver best practice nutrition care for residents into the future.

Systematic Review of the Impact of Behavioral Health Homes on Cardiometabolic Risk Factors for Adults With Serious Mental Illness.

OBJECTIVE: This systematic review examined the impact of health homes on cardiometabolic risk among adults with serious mental illness. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures were used to conduct the systematic review. Databases were searched for peer-reviewed articles published between 1946 and August 2018 that compared health homes with a control condition (e.g., usual care and secondary data analyses using matched samples). Participants, interventions, comparisons, outcomes, and study design criteria were used to assess study eligibility. Studies were assessed for methodological quality by using the Quality Assessment of Before and After Studies With No Control Group and the Quality Assessment of Controlled Intervention Studies. RESULTS: Eighteen studies (i.e., 11 observational studies, four quasi-experimental studies, and three randomized controlled trials) reported on 17 health homes. Most studies reported increases in receipt of screening for cardiometabolic risk factors and service use. There was a modest reduction in selected cardiometabolic risk factors among people with serious mental illness, but clinical outcomes varied widely among studies. CONCLUSIONS: Improvement in cardiometabolic risk factors varied across the studies, and the clinical significance of these reductions was not clear. Peer support and self-management training may represent strategies to improve cardiometabolic risk factors. Colocation of services may not be enough to significantly affect cardiometabolic risk factors. Health homes that include standardized screening, peer support and self-management training, and intervention components that target interdependent risk factors may have a greater impact on clinical outcomes.

A novel approach to improve stress regulation among traumatized youth in residential care: Feasibility study testing three game-based meditation interventions.

AIM: Many youth in residential care suffer from post-traumatic symptoms that have adverse effects on a range of psychological, behavioural and physiological outcomes. Although current evidence-based treatment options are effective, they have their limitations. Meditation interventions are an alternative to traditional trauma-focused treatment. This pilot study aimed to evaluate three game-based meditation interventions in a sample of traumatized youth in residential care. METHODS: Fifteen participants were randomly divided over three conditions (Muse, DayDream and Wild Divine) that all consisted of twelve 15-minute game-play sessions. Physiological measurements (heart rate variability) were conducted at baseline, post-treatment and during each intervention session. Post-traumatic symptoms, stress, depression, anxiety and aggression were assessed at baseline, post-treatment and 1-month follow-up. RESULTS: Physiological stress regulation was improved during the meditation sessions of all three interventions. User evaluations were in particular high for Muse with a rating of 8.42 out of 10 for game evaluation. Overall, outcomes on psychopathology demonstrated the most robust effect on stress. Muse performed best, with all participants showing reliable improvements (reliable change indexes [RCIs]) in post-traumatic symptoms, stress and anxiety. Participants who played Daydream or Wild Divine showed inconsistent progression: some participants improved, whereas others remained stable or even deteriorated based on their RCIs. CONCLUSIONS: Preliminary findings show promising outcomes on physiology, psychopathology and user evaluations. All indicate the potential of this innovative form of stress regulation intervention, and the potential of Muse in particular, although findings should be considered preliminary due to our small sample size. Further studies are warranted to assess intervention effectiveness effects of Muse or other game-based meditation interventions for traumatized youth.

Indoor Nature Interventions for Health and Wellbeing of Older Adults in Residential Settings: A Systematic Review.

BACKGROUND AND OBJECTIVES: Having contact with nature can be beneficial for health and wellbeing, but many older adults face barriers with getting outdoors. We conducted a systematic review of quantitative studies on health and wellbeing impacts of indoor forms of nature (both real and simulated/artificial), for older adults in residential settings. RESEARCH DESIGN AND METHODS: Search terms relating to older adults and indoor nature were run in 13 scientific databases (MEDLINE, CINAHL, AgeLine, Environment Complete, AMED, PsychINFO, EMBASE, HMIC, PsychARTICLES, Global Health, Web of Knowledge, Dissertations and Theses Global, and ASSIA). We also pursued grey literature, global clinical trials registries, and a range of supplementary methods. RESULTS: Of 6,131 articles screened against eligibility criteria, 26 studies were accepted into the review, and were quality-appraised using the Effective Public Health Practice Project (EPHPP) tool. The participants were 930 adults aged over 60. Nature interventions and health/wellbeing outcomes were heterogeneous, which necessitated a narrative synthesis. The evidence base was generally weak, with 18 of 26 studies having a high risk of bias. However, several higher-quality studies found indoor gardening and horticulture programs were effective for cognition, psychological wellbeing, social outcomes, and life satisfaction. DISCUSSION AND IMPLICATIONS: There is inconsistent evidence that indoor nature exposures are beneficial for older care residents. We expect that successful interventions were, at least partly, facilitating social interaction, supporting feelings of autonomy/control, and promoting skill development, that is, factors not necessarily associated with nature per se. Higher-quality studies with improved reporting standards are needed to further elucidate these mechanisms.

The use of finger foods in care settings: an integrative review.

BACKGROUND: Reduced food intake is prevalent in people in residential and hospital care settings. Little is known about the use of finger foods (i.e. foods eaten without cutlery) with respect to increasing feeding independence and food intake. The Social Care Institute for Excellence (Malnutrition Task Force: State of the Nation, 2017) recommends the use of finger foods to enable mealtime independence and to prevent loss of dignity and embarrassment when eating in front of others. The aim of this review is to identify and evaluate the existing literature regarding the use and effectiveness of finger foods among adults in health and social care settings. METHODS: An integrative review methodology was used. A systematic search of electronic databases for published empirical research was undertaken in October 2018. Following screening of titles and abstracts, the full texts of publications, which investigated outcomes associated with the provision of finger foods in adult care settings, were retrieved and assessed for inclusion. Two independent investigators conducted data extraction and quality assessment using Critical Appraisal Skills Programme checklists. Thematic analysis was used to summarise the findings. RESULTS: Six studies met the inclusion criteria. Four themes were identified: Finger food menu implementation; Importance of a team approach; Effect on nutrition; and Influence on wellbeing. Study designs were poorly reported, with small sample sizes. CONCLUSIONS: There is some evidence that the provision of finger foods may positively affect patient outcomes in long-term care settings. There is a paucity of research evaluating the use of a finger food menu in acute care settings, including economic evaluation. Future high quality trials are required.

Is the holistic physical factor linked to life satisfaction in older age?

BACKGROUND: The physical factor (health literacy, health status, functional ability to perform daily basic and instrumental activities and risk factors) is linked to life satisfaction in older age. The aim of this study is to establish the correlation between the physical holistic factor and life satisfaction in older age. MATERIAL AND METHODS: The quantitative research method was used. In order to sample the data, the authors chose a simple random sample. The designed questionnaire was filled in by 1064 older persons aged ≥ 65 years, living in social care institutions/nursing homes for older persons or in the home environment. The number of correctly completed survey questionnaires was 656. In order to measure life satisfaction, the Satisfaction with Life Scale was used. Within the physical factor, 4 indexes were formed. In order to be able to show the desired influences or links between the physical factor and life satisfaction, the authors used propensity score methods. RESULTS: The individual indexes within the physical factor are linked to life satisfaction to a varying degree: health literacy (R2 = 0.137), health status (R2 = 0.047), the functional ability to perform daily basic and instrumental activities (R2 = 0.015), and risk factors (R2 = 0.001). The physical holistic factor is linked to life satisfaction in older age (R2 = 0.05). CONCLUSIONS: With this research, the authors have proven that the older persons with high levels of health literacy, a good health status without chronic diseases, who are independent in performing daily basic and instrumental activities, and do not have any risk factors present, are more satisfied with their lives. Med Pr. 2019;70(5):535-43.

Facilitating Imagine Arts in residential care homes: the artists' perspectives.

INTRODUCTION: This study explores factors affecting the successful facilitation of a residential arts programme. The aim was to identify barriers and describe how they could be overcome, this was both formative, to help shape the programme, and summative, to inform best practice and future arts interventions. METHODS: An exploratory qualitative design examined the views of the artists administering the arts programme. RESULTS: Data were analysed using thematic analysis. Four main themes were identified; contextual factors, perceiving and responding to needs, facilitating relationships and building confidence. CONCLUSION: Findings provide insight into practical aspects of facilitating arts programmes in residential care. Some of the identified barriers may have simple solutions which can easily be incorporated into everyday best practice. This research provides a start for understanding the role of artists within care homes and how they aid the implementation and integration of arts programmes into the care of people with dementia.