Predictors of Deterioration in Mental Well-Being and Quality of Life among Family Caregivers and Older People with Long-Term Care Needs during the COVID-19 Pandemic.

BACKGROUND: During the COVID-19 pandemic, reduced access to care services and fear of infection prompted families to increase home care for their older relatives with long-term care needs. This had negative effects on both members of the caring dyad, impacting their quality of life (QoL) and mental well-being. This study investigated the factors that influenced the mental well-being and QoL of 239 dyads, before and after the first pandemic wave in Italy. METHODS: Data were collected through a survey on the use of health and social care services and interventions by older care recipients living in the community and their family caregivers. Factors associated with deterioration of mental well-being and QoL in older care recipients (mean age 86.1 years old) and their family caregivers after the pandemic were studied. RESULTS: The importance attached by family caregivers to the skills and training of healthcare professionals was a protective factor against the deterioration in the well-being of older care recipients. Similarly, the importance associated by family caregivers to the help received from healthcare professionals was a protective factor for QoL. Financial hardship of older care recipients was a risk factor for deterioration in caregivers' mental well-being, while support from other family members was a protective factor for QoL. CONCLUSIONS: The presence of attentive healthcare professionals, a supportive family environment, and economic support can reduce the burden on both the caregiver and the older care recipient. These aspects need to be considered in any future emergency situation and when planning care services for community-dwelling older people.

Study protocol for a feasibility study of an online educational programme for people working and living with persistent low back pain.

BACKGROUND: Low back pain (LBP) is the main cause of activity limitation and work absence across the world, leading to a high social and economic burden for individuals, families, the labour market and society. The overall aim of this multicentre study is to test the usability, acceptability and feasibility of an evidence-based, digital education programme for people living and working with persistent LBP who are in sedentary or physically demanding jobs and need advice on ergonomics, self-management of pain and healthy behavioural strategies. METHODS: This is the protocol of a multinational, multicentre, prospective uncontrolled feasibility study targeting people with persistent LBP in Lithuania, Northern Ireland, Italy, Sweden and Portugal. Eligible participants will be offered the opportunity to use the MyRelief educational platform as part of their care and will undergo evaluations at baseline (enrollment) and 1-month follow-up. Feasibility will be assessed using measures of recruitment and retention, intervention engagement, outcome measure completion rates and within-group effect sizes in response to the digital education programme. DISCUSSION: This study will identify the challenges and implications of delivering a digital training programme in advance of potentially delivering the programme via an online educational platform available on mobile devices. The findings will inform the design of a future randomised controlled trial if it proves feasible. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04673773 . Registered 17 December 2020.

Effects of Ciprofloxacin Alone or in Mixture with Sulfamethoxazole on the Efficiency of Anaerobic Digestion and Its Microbial Community.

Some livestock farms rely on anaerobic digestion (AD) technology for manure disposal, thus obtaining energy (biogas) and fertilizer (digestate). Mixtures of antibiotics used for animal health often occur in organic waste and their possible synergistic/antagonistic effects on microorganisms involved in AD are still poorly studied. This work focuses on the effects of adding ciprofloxacin, alone (5 mg L-1) and in combination with sulfamethoxazole (2.5-5-10 mg L-1), on AD efficiency and microbial community structure. The experiment consisted of 90-day cattle manure batch tests and antibiotic removal percentages were assessed. Adding antibiotics always promoted CH4 and H2 production compared to untreated controls; however, CH4 production was lowered with the highest ciprofloxacin (CIP) concentrations. The overall results show antibiotic degradation caused by acidogenic Bacteria, and CH4 was mainly produced through the hydrogenotrophic-pathway by methanogenic Archaea. Shifts in microbial community abundance (DAPI counts) and composition (Illumina-MiSeq and FISH analyses) were observed.

Can a Green Care Informal Learning Program Foster Active Aging in Older Adults? Results From a Qualitative Pilot Study in Central Italy.

Due to population aging worldwide, it is important for Health Care Systems to design new services fostering Active Aging dimensions (e.g., physical health, psychological well-being, social engagement, and lifelong learning). The aim of this pilot study was to develop new services fostering Active Aging dimensions by means of a 12-month green care informal learning program targeting 112 individuals among community-dwelling older people and day care center users. The impact of the intervention was assessed through three rounds of focus groups. Individuals' perception of the training benefits depended on their health and social condition at baseline. The program improved the social participation and learning attitudes of community-dwelling older people and the perceived well-being and health of day care center users. Green care activities triggered an Active Aging virtuous spiral where learning new practical and relational competencies helped older people recognize their value. Thus, it is recommendable to include green care therapy within the practice of services for older people, especially day care centers.

Benefits for Older People Engaged in Environmental Volunteering and Socializing Activities in City Parks: Preliminary Results of a Program in Italy.

The objective of this pilot study was to investigate the feasibility of an environmental volunteering program involving park restoration and social activities for older people. Older people face a series of challenges, ranging from social isolation and depression to a lack of exercise, as well as the difficult task of creating new meaning to deal with a decrease in vitality and new social relationships, interests, and commitments. From this perspective, this pilot study aimed to contribute to highlighting if or how these aspects can be positively correlated with organized activities associated with caring for public green spaces. A single-group, pre-test/post-test design was used, and baseline and post-participation measurements were recorded. The data were collected using a questionnaire aimed at evaluating variations in physical activity, positive and negative emotions, life satisfaction, and perceived social support. Through focus group interviews with participants at the baseline and after one year of participating in the program, the participants' motivations and experienced effects were explored. The sample was composed of a group of 19 healthy people who joined the program. The quantitative results showed that the participants' level of physical activity, subjective life satisfaction, and positive feelings were significantly increased at the follow-up. Positive correlations were found between increasing moderate physical activities, walking, and The Positive and Negative Affect Schedule (PANAS) positive feelings. A pro-environmental attitude of the elderly emerged from the qualitative data. The results, limitations, and improvements of the study are discussed.

Review and Selection of Online Resources for Carers of Frail Adults or Older People in Five European Countries: Mixed-Methods Study.

BACKGROUND: Informal carers have a crucial role in the care of older people, but they are at risk of social isolation and psychological exhaustion. Web-based services like apps and websites are increasingly used to support informal carers in addressing some of their needs and tasks, such as health monitoring of their loved ones, information and communication, and stress management. Despite the growing number of available solutions, the lack of knowledge or skills of carers about the solutions often prevent their usage. OBJECTIVE: This study aimed to review and select apps and websites offering functionalities useful for informal carers of frail adults or older people in 5 European countries (Cyprus, Greece, Italy, Portugal, and Sweden). METHODS: A systematic online search was conducted from January 2017 to mid-March 2017 using selected keywords, followed by an assessment based on a set of commonly agreed criteria and standardized tools. Selected resources were rated and classified in terms of scope. Focus groups with informal carers were conducted to validate the list and the classification of resources. The activities were conducted in parallel in the participating countries using common protocols and guidelines, a standardization process, and scheduled group discussions. RESULTS: From a total of 406 eligible resources retrieved, 138 apps and 86 websites met the inclusion criteria. Half of the selected resources (109/224, 48.7%) were disease-specific, and the remaining resources included information and utilities on a variety of themes. Only 38 resources (38/224, 17.0%) were devoted specifically to carers, addressing the management of health disturbances and diseases of the care recipient and focusing primarily on neurodegenerative diseases. Focus groups with the carers showed that almost all participants had no previous knowledge of any resource specifically targeting carers, even if interest was expressed towards carer-focused resources. The main barriers for using the resources were low digital skills of the carers and reliability of health-related apps and websites. Results of the focus groups led to a new taxonomy of the resources, comprising 4 categories: carer's wellbeing, managing health and diseases of the care recipient, useful contacts, and technologies for eldercare. CONCLUSIONS: The review process allowed the identification of online resources of good quality. However, these resources are still scarce due to a lack of reliability and usability that prevent users from properly benefiting from most of the resources. The involvement of end users provided added value to the resource classification and highlighted the gap between the potential benefits from using information and communication technologies and the real use of online resources by carers.

The use of nature - based activities for the well-being of older people: An integrative literature review.

BACKGROUND: During the last decades scientific literature has focused on the positive relationships between Nature - Based Activities (NBA) and health. The aging of the population and the increasing costs of health services make it important to investigate the benefits for older people. OBJECTIVE: The purpose of this study was to systematically review the existing literature regarding Nature - Based Activities addressed to older people. METHODS: A systematic search of the literature was made in PubMed, Web of Science and Scopus from 2005 till December 2018. RESULTS: We identified 42 articles that satisfied the inclusion criteria. The results highlighted the multidisciplinary use of nature in many settings as well as a variety of different research designs, both quantitative and qualitative. The majority of experimental assessments were carried out in the setting of nursing homes and residential facilities. A variety of treatments, e.g. horticultural therapy, gardening, green visiting, green exercise and of settings, e.g. residential facilities or adult day services, participants' homes, outdoor settings, and green care farms were examined. CONCLUSIONS: The examined studies offered numerous examples of the healing power of nature for the health and well-being of older people. Occupational therapists could gain substantial insight from earlier experiences of NBA for application in their practices.

A pilot programme evaluation of social farming horticultural and occupational activities for older people in Italy.

The aim of this study was to evaluate a 1-year social farming programme conducted between 2014 and 2015, including horticultural and occupational activities on six agricultural farms for older people in good general health. Social farming is a practice that uses agricultural resources to provide health, social or educational services to vulnerable groups of people. Activity participation, social relationships, physical activity, and the quality of life of the participants were assessed using a pretest, posttest design. A total of 112 subjects were interviewed at baseline, though only 73 participants were retained through the end of the follow-up, resulting in a dropout rate of 34%. Data analysis revealed significant improvements in both social relationships and overall occupational engagement at the end of the programme, with significant increases in the frequency of contact with friends or relatives as well as the number of activities performed by the participants. This work adds to the literature on the effects of social farming and indicates that farming may provide opportunities for older people to engage in activities that stimulate social behaviours.