Helpful Approaches for Older Adults Living in a Retirement Community to Move Forward After the Death of a Significant Other.

The loss of a significant other often creates emotional distress for family members that can hamper the ability to meet everyday challenges and pursue wellness. The aim of this qualitative study was to understand the challenge of losing a significant other for older adult family members and the approaches identified as most helpful to promote their own well-being after this person dies. Story inquiry method guided the interview process with 15 older adult bereaved family members residing in a continuing care retirement community. Theory-guided content analysis was used for data analysis. Two themes described the challenges: uneasiness that permeates everyday living and precious memories and patterns of disconnect that breed discontent. Appreciating the rhythmic flow of everyday connecting and separating and embracing reality as situated in one's lifelong journey are the themes that encompass the helpful approaches used by participants. This study provided insights about the benefits of living in this community such as social networking and a possible drawback such as the frequency of death among residents. Future research should continue to investigate social service resources that older adults find most helpful after a significant other dies and the use of reminiscence groups as a form of bereavement support.

Establishing Effective Resident and Family Councils: A Pilot Project to Increase Family and Resident Engagement in Alberta's Continuing Care Sites.

Resident and family councils aim to improve resident and family satisfaction, but guidelines for councils are scarce. This project developed a toolkit and tested its ability, along with networking meetings, to promote successful councils. Nine continuing care sites participated with residents, family and staff from each site who received the toolkit, completed surveys, attended meetings and participated in post-pilot interviews. Participants found that the toolkit helped improve council function and, with the networking meetings, increased participation. All sites found the toolkit and networking meetings to be valuable resources and had a strong desire to have them available in the future.

An in-depth discussion and illustration of partial least squares structural equation modeling in health care.

Partial least squares structural equation modeling (PLS-SEM) has become more popular across many disciplines including health care. However, articles in health care often fail to discuss the choice of PLS-SEM and robustness testing is not undertaken. This article presents the steps to be followed in a thorough PLS-SEM analysis, and includes a conceptual comparison of PLS-SEM with the more traditional covariance-based structural equation modeling (CB-SEM) to enable health care researchers and policy makers make appropriate choices. PLS-SEM allows for critical exploratory research to lay the groundwork for follow-up studies using methods with stricter assumptions. The PLS-SEM analysis is illustrated in the context of residential aged care networks combining low-level and high-level care. Based on the illustrative setting, low-level care does not make a significant contribution to the overall quality of care in residential aged care networks. The article provides key references from outside the health care literature that are often overlooked by health care articles. Choosing between PLS-SEM and CB-SEM should be based on data characteristics, sample size, the types and numbers of latent constructs modelled, and the nature of the underlying theory (exploratory versus advanced). PLS-SEM can become an indispensable tool for managers, policy makers and regulators in the health care sector.

Pain Treatment Practices of Community-Dwelling Black Older Adults.

Black older adults often experience disparities in pain treatment that results in unmet pain needs. The aims of this study were to assess the pain management experiences of a group of community dwelling Black older adults and identify gaps in clinical practice. A qualitative, descriptive design was employed using the methodology of ethnography. The setting was an urban, low-income, community elderly housing high-rise facility. Participants included facility residents (n = 106); of these, 20 completed structured qualitative interviews. The Brief Pain Inventory and qualitative interviews were used to determine pain prevalence, treatment practices, and barriers. Eighty-six percent of the participants had severe pain with a mean worst pain rating of 7 on a 0 to 10 scale. Pain interfered moderately with general activity (5.59), walking (5.73) and normal work (5.70), also measured on 0 to 10 scales. Participants preferred non-opioid analgesics, topical over-the-counter treatments, and nonpharmacological interventions such as prayer/meditation, and exercise for treatment. Medications most commonly used by participants for pain management included, hydrocodone with acetaminophen (28.6%), nonsteroidal anti-inflammatory drugs (13.2%), acetaminophen with codeine (12%), and tramadol (9.9). Qualitative interviews revealed that pain management barriers were centered around communication concerns about side effects, fears of addiction, and provider mistrust. A communication gap exists between patients and providers. Discussing patient treatment preferences, providing balanced treatment information, and following-up with patients on treatment plan effectiveness by phone can improve how pain is managed for Black older adults.

[Potential of cooperative learning in project development : Relevance of cooperative participation procedure for the further development of generation-appropriate accomodation in structurally weak rural areas]. / Potenziale kooperativen Lernens in der Projektentwicklung : Relevanz kooperativer Beteiligungsverfahren für die Weiterentwicklung generationengerechter Wohnformen in strukturschwachen ländlichen Räumen.

BACKGROUND: A joint initiative of existing senior care organizations, the municipality of Meyenburg and the state of Brandenburg was further developed by affiliation of an institute of the Brandenburg University of Technology Cottbus-Senftenberg (ABV) in cooperation with members of the architecture and social work departments in 2014. MATERIAL AND METHODS: A cooperative process between different players was central to create an appropriate structure of services for this region. RESULTS: Cooperative projects are necessary to establish new forms of generation-appropriate living and care concepts in rural areas. CONCLUSION: Cooperative learning methods are needed to develop new forms of generation-appropriate living and care concepts in rural areas, which take the diversity of elderly people, the rural context, intergenerational residential arrangements and affordable accommodation that meets the requirements of the social security system into account. Furthermore, the project had to reflect the recent developments of the German care insurance. The article describes the participatory methods, the coordination process and the resulting concept.

Do not hear, see, or speak: views of older residents and their adult children about the nursing unit in the continuing care retirement community.

BACKGROUND: The present study evaluated views of continuing care retirement community (CCRC) residents and their adult children concerning the nursing unit (NU) within the CCRC. METHODS: Qualitative interviews with older adults and their adult children were conducted. Analysis consisted of 187 interviews with older adults and their adult children over a period of up to six years. Analysis relied on constant comparisons within the same interview, over interviews of the same person over time, and between CCRC residents and their adult children. Major themes were identified to construct a coherent storyline. RESULTS: The NU was viewed as a different universe that should be avoided at all costs. This was attributed to: (1) the association of the NU with one's impending decline and dependence and (2) beliefs about substandard care in the NU. CONCLUSIONS: The findings point to the ambivalence expressed by CCRC residents and their adult children concerning the NU, even though to some degree, the NU represents the main reason for the transition to a CCRC.

The rote administrative approach to death in senior housing: Using the other door.

Understanding death in long-term care (LTC) facilities and the preexisting standards and policies pertaining to the death experience in LTC is essential. Qualitative interviews were conducted with 10 administrators of CCRCs and data analyzed through content analysis. Results of the current study reveal that administrators spoke of approaching death in their facility similar to any other procedural task, removal of the residents' bodies varied by community, and coordination responsibilities ranged from maintenance crews to management. Notification practices for residents and staff were also inconsistent. Differences existed in internal cultures on providing forms of respect. These practices were standard for some facilities while others were flexible to accommodate family requests. The majority of the sites did not offer additional training on death and dying for staff members. Findings suggest the need for consistency regarding how senior housing administrators approach the death of a resident and provide support for staff members.

Exploring socioecological correlates of active living in retirement village residents.

This study explored individual, social, and built environmental attributes in and outside of the retirement village setting and associations with various active living outcomes including objectively measured physical activity, specific walking behaviors, and social participation. Residents in Perth, Australia (N = 323), were surveyed on environmental perceptions of the village and surrounding neighborhood, self-reported physical activity, and demographic characteristics and wore accelerometers. Managers (N = 32) were surveyed on village characteristics, and objective neighborhood measures were generated in a Geographic Information System (GIS). Results indicated that built- and social-environmental attributes within and outside of retirement villages were associated with active living among residents; however, salient attributes varied depending on the specific outcome considered. Findings suggest that locating villages close to destinations is important for walking and that locating them close to previous and familiar neighborhoods is important for social participation. Further understanding and consideration into retirement village designs that promote both walking and social participation are needed.

[Residential mobility in old age. Age-appropriate housing as a primary preventive strategy]. / Wohnmobilität im Alter. Altersgerechtes Wohnen als primärpräventive Strategie.

BACKGROUND: Unfavorable living conditions in old age have negative physical, psychological and social implications and increase the risk of institutionalization. The aim of this study is to examine older adults' readiness to relocate to age-appropriate housing versus the wish to stay where they are. METHODS: A total of 103 older men and women were questioned prospectively, face-to-face, regarding their readiness to relocate. In addition to assessing several established predictors of residential mobility, data on objective living situations were collected. The data were subjected to bi- and multivariate analysis. RESULTS: At 70.9%, the proportion of respondents who are not willing to move (stayers) far exceeds the proportion of those who are (movers, 29.1%). Older respondents are more satisfied with their living situation and less likely to move. This study provides empirical evidence for the "satisfaction paradox" with respect to living conditions and for the importance of the subjective standard of living for quality of life in old age. CONCLUSION: Modern housing counseling should more strongly reflect the variety of needs, requirements and living situations of older people today than it has done in the past. It is therefore recommended that the currently dominating paradigm of "aging in place" be critically re-evaluated.

[Woongroepen, an original way of caring for elderly people]. / Une prise en charge originale des personnes âgées avec les woongroepen.

A group of eleven third-year students and two trainers from the Nancy nurse training institute visited the Netherlands in the framework of an optional unit focusing on European approaches in nursing studies. During their stay, they discovered an original type of collective accommodation, called woongroep, which helps to improve elderly people's quality of life.

Reclaiming time for nursing practice in nutritional care: outcomes of implementing Protected Mealtimes in a residential aged care setting.

AIMS: To improve nutritional care and the mealtime experience of older people in a residential aged care setting by assisting nurses to create change to their practice and to the mealtime environment. BACKGROUND: Despite being preventable and treatable, inadequate nutrition remains a problem for many older people in residential aged care and tertiary health care settings. Nevertheless, many organisations are uniquely positioned to implement solutions that will lead to better care. DESIGN: The study used a qualitative, action research approach, grounded in the participatory worldview. METHODS: The multimethod approach of data and between-method triangulation were chosen to assist in understanding the multidimensional issues associated with resident mealtimes and the provision of nutritional care. The collection of non-participant observations was informed by aspects of the Developmental Research Sequence. Action group meetings and non-participant observations were qualitatively analysed using the Analytic Hierarchy. RESULTS: Protected Mealtimes was tailored for the residential aged care unit. The most significant change involved the transformation of system processes by creating the space in nurses' busy schedules and thus reclaiming time for nurses to reconnect with nutritional care. Fixed role boundaries were made flexible by assisting individuals to understand and extend their roles in nutritional care. Most importantly, sustainability of Protected Mealtimes was achieved and long-term changes around nutritional care continued to be resident focused. CONCLUSIONS: This study demonstrates that lasting changes to nursing practice in nutritional care can be achieved by applying the principles of a participatory worldview and action research. RELEVANCE TO CLINICAL PRACTICE: CHANGE is challenging to achieve in complex health care organisations. This study bridges the gap between theory and practice and has shown that nurses can create change by employing a participatory worldview and action research as part of their toolkit for problem solving.

The Tool for Understanding Residents' Needs as Individual Persons (TURNIP): construction and initial testing.

AIMS AND OBJECTIVES: To construct and evaluate an intervention tool for increasing the person-centredness of care in residential aged care services. BACKGROUND: Providing care that is person-centred and evidence-based is increasingly being regarded as synonymous with best quality aged care. However, consensus about how person-centred care should be defined, operationalised and implemented has not yet been reached. DESIGN: Literature reviews, expert consultation (n = 22) and stakeholder interviews (n = 67) were undertaken to develop the Tool for Understanding Residents' Needs as Individual Persons (TURNIP). METHODS: Statistical estimates of validity and reliability were employed to evaluate the tool in an Australian convenience sample of aged care staff (n = 220). RESULTS: The 39 item TURNIP conceptualised person-centred care into five dimensions: (1) the care environment, (2) staff members' attitudes towards dementia, (3) staff members' knowledge about dementia, (4) the care organisation and (5) the content of care provided. Psychometric testing indicated satisfactory validity and reliability, as shown for example in a total Cronbach's alpha of 0·89. CONCLUSIONS: The TURNIP adds to current literature on person-centred care by presenting a rigorously developed intervention tool based on an explicit conceptual structure that can inform the design, employment and communication of clinical interventions aiming to promote person-centred care. RELEVANCE TO CLINICAL PRACTICE: The TURNIP contains clinically relevant items that are ready to be applied in clinical aged care. The tool can be used as a base for clinical interventions applying discussions in aged care organisations about the quality of current care and how to increase person-centredness of the care provided.

Creating a therapeutic milieu in retirement communities.

Elderly persons' relocation to retirement communities is a stressful event that requires person-milieu adjustment. Research has shown differences in relocation adjustment for elders residing in different retirement communities. A secondary analysis used findings from a study of relocated elders in order to determine whether certain therapeutic factors were lacking in retirement communities where elders had difficulty in adjusting. Study participants were 104 elders who relocated to six retirement communities in Northeast Ohio. This study analyzed qualitative data from the researchers' observations and field notes and narratives obtained from the elders who participated in the original study. The analysis focused on data that described the environmental characteristics of retirement communities where elders reported less successful adjustment. These environmental characteristics were evaluated for consistency with the characteristics of Shives' therapeutic milieu. Most retirement communities in the study did not fulfill all eight dimensions of a therapeutic milieu as defined by Shives. For example, individualized treatment programs were lacking in most of the retirement communities and the activities offered were not based on individual assessment and did not contribute to personal growth. The findings point to the need to create a more therapeutic milieu in retirement communities in order to facilitate successful readjustment for relocated elders.

The impact of health-related supports in senior housing on ambulance transfers and visits to emergency departments: The Right Care, Right Place, Right Time Project.

OBJECTIVE: To test the impact of placing a wellness team (nurse and social worker) in senior housing on ambulance transfers and visits to emergency departments over 18 months. DATA SOURCES/STUDY SETTING: Intervention sites included seven Boston-area buildings, with five buildings at comparable settings acting as controls. Data derive from building-level ambulance data from emergency responders; building-level Medicare claims data on emergency department utilization; and individual-level baseline assessment data from participants in the intervention (n = 353) and control (n = 208) sites. STUDY DESIGN: We used a pre/postdifference in difference quasi-experimental design applying several analytic methods. The preintervention period was January 2016-March 2017, while the intervention period was July 2017-December 2018. DATA COLLECTION/EXTRACTION METHODS: Emergency responders provided aggregate transfer data on a daily basis for intervention and control buildings; the Quality Improvement Organization provided quarterly aggregate data on emergency department visit rates; and assessment data came from a modified Vitalize 360 assessment and coaching tool. PRINCIPAL FINDINGS: The study found an 18.2% statistically significant decline in ambulance transfers in intervention buildings, with greater declines in buildings that had fewer services available at baseline, compared to other intervention sites. Analysis of Medicare claims data, adjusted for the proportion of residents over 75 per building, found fewer visits to emergency departments in intervention buildings. CONCLUSIONS: Health-related supports in senior housing sites can be effective in reducing emergency transfers and visits to emergency departments.

Fostering social work gerontological competencies: qualitative analysis of an intergenerational service-learning course.

This article describes the development and qualitative student outcomes of an intergenerational service-learning course designed to promote social work gerontological competencies. Efforts focused on creating a learning environment to actively promote learning opportunities for students and older adults. The course was hosted at a local, private, not-for-profit senior housing location where older adults were invited to actively participate in the course activities. A total of 37 undergraduate and graduate students completed the course. Content and narrative analysis was conducted using text from a final structured reflective journal assignment. This analysis identified themes related to the "explicit" and "implicit" pedagogy of the course that details students' educational growth. The results of this study indicate that intergenerational service-learning coursework may help foster geriatric competencies among graduate and undergraduate students. The benefits of utilizing social work gerontological competencies to guide course objectives, content, and student outcomes are discussed.

A military home with a heart.

A classically inspired and iconic building by the Thames in south west London, the Royal Hospital Chelsea is home to the equally iconic Chelsea pensioners--retired ex-military staff who have come to live in this unique retirement community. Now the nursing needs of this special group are being met in a new wing of the site, called the Margaret Thatcher Infirmary.

The Impact of Cohousing on Older Adults' Quality of Life.

The global population including Canada's is aging, which demands planning for housing that will support older adults' quality of life. This mixed-method study is the first Canadian study to examine the impact of cohousing on older adults' quality of life and involved 23 participants. The older adults rated their quality of life very high, especially in the environmental, physical, and psychological domains of the World Health Organization Quality of Life (WHOQOL_BREF) survey; quality of life in the social domain was rated low, which was surprising in light of the focus group data findings. Four themes of "belonging in a community", "life in the community", "changes associated with aging," and "aging in place" emerged from the qualitative data to explain factors that influence older adults' quality of life. This research provides foundational, strong evidence that seniors' cohousing is an innovative housing solution that can support older adults' quality of life.

'You have got to stick to your times': Care workers and managers' experiences of working in extra care housing.

Extra care housing (ECH) has been lauded as an innovative model of housing with care for older people that promotes and supports independent living. The study used a qualitative design to explore how care is delivered in four extra care settings in England over 20 months during 2016-2017. This paper reports findings from semi-structured interviews with 20 care workers and seven managers. The article argues that, despite being heralded as a new model, care workers in ECH face similar organisational pressures as those working in more conventional settings and, in turn, the care which they are able to provide to residents mimics traditional forms of care.