The Involvement of Caregivers in the End-of-life Care of an Older Adult Living in a Long-term Care Home: A Qualitative Case Study with Nurses and Relatives.

BACKGROUND: A key role of nurses working in long-term care homes (LTCHs) is to promote the involvement of care partners in end-of-life (EOL) care. However, studies on the involvement of care partners in EOL care in LTCHs have focused on care planning and decision-making. While care partners can participate in other ways, it's unclear how they are currently involved in EOL care by staff. PURPOSE: We aimed to explore the involvement of care partners in the EOL care of an older adult living in a LTCH. METHODS: A qualitative case study was conducted. Data was collected from a sample of four nurses and three care partners, using sociodemographic questionnaires, individual semi-structured interviews, documents pertaining to the LTCH's philosophy for EOL care, and a field diary. RESULTS: The results of a thematic analysis showed the broad scope of care partners' possible involvement, including contributing to care, obtaining information, and being present. As there was some variation in care partners' desire to be involved, nurses seemed to rely on them to convey their wishes. To promote this involvement, some strategies aimed at health professionals and managers were suggested. CONCLUSIONS: These results can guide improvement in clinical practices and raise awareness on the EOL care experiences of care partners.

Perspectives of family caregivers and nurses on hospital discharge transitional care for Muslim older adults living with COPD: a qualitative study.

BACKGROUND: The increased number of emergency department visits among older adults living with chronic obstructive pulmonary disease reflects the challenges of hospital discharge transition, especially in those from a cultural minority. The barriers and facilitators of this discharge from the perspective of formal and informal care providers, such as nurses and family caregivers, are important to identify to provide effective symptom management and quality of care. The purpose of this study was to describe the barriers and facilitators in caring for Muslim older adults with chronic obstructive pulmonary disease (COPD) during hospital discharge transitional care. METHODS: A descriptive qualitative study was conducted in a hospital of Thailand where Muslim people are a cultural minority. Thirteen family caregivers of Muslim older adults living with COPD and seven nurses were purposively recruited and participated in semi-structured interviews and focus group discussions. Content analysis was used to analyze the data. RESULTS: Five barriers and three facilitating factors of transitional care for Muslim older adults living with COPD were outlined. Barriers included: (1) lack of knowledge about the causes and management of dyspnea, (2) inadequate discharge preparation, (3) language barrier, (4) discontinuity of care, and (5) COVID-19 epidemic. Facilitators included: (1) the ability to understand Malayu language, (2) the presence of healthcare professionals of the same gender, and (3) the presence of Muslim healthcare providers. CONCLUSION: Family caregivers require more supportive care to meet the care needs of Muslim older adults living with COPD. Alternative nurse-based transitional care programs for these older adult caregivers should be developed.

At the Epicentre of the COVID-19 Pandemic in Canada: Experiences and Recommendations of Family Care Partners of an Older Person Living in a Long-Term Care Home.

The roles of family care partners of older persons living in long-term care homes (LTCH) were severely disrupted during the coronavirus disease (COVID-19) pandemic. Our aim was to describe their experiences and to solicit their recommendations for supportive actions. We conducted a critical ethnography with 24 care partners who cared or had cared for an older person living in an LTCH in Québec during the COVID-19 pandemic. We collected data during interviews and used Spradley's method to analyse them. Care partners experienced a forced separation from the older persons they cared for, which resulted in significant distress. Care, including post-mortem care, was considered inadequate and sometimes even inhumane. Communication was inconsistent, and this variability was also noted in visitation rules. Care partners perceived LTCHs as a neglected community. Supportive actions were recommended. The results illustrated the essential contribution of care partners, and the supportive actions they recommended must be a catalyst for change toward more humane care in LTCH settings.

'Intensive palliative care': a qualitative study of issues related to nurses' care of people with amyotrophic lateral sclerosis at end-of-life.

Background: Amyotrophic lateral sclerosis (ALS) is currently an incurable and fatal disease, which often comes with a high symptom burden at the end-of-life stage. Little is known about nurses' experiences in this context. Objective: To explore the experience of nurses caring for people with ALS at end-of-life. Design: A qualitative multiple-case study design. Method: Individual semi-structured interviews were conducted between February and August 2022 with nurses from Quebec, Canada, who had provided care to at least one person living with ALS at the end-of-life in the past 12 months. The content analysis method was used for data analysis and within-case and cross-case analyses were conducted, as well as comparative analyses according to the type of position held by the participants that determined the cases: (1) home care, (2) hospital and (3) palliative care home. Results: Participating in the study were 24 nurses: 9 were from home care, 8 from hospitals and 7 from palliative care homes. Five main themes were identified: (1) identifying the end-of-life period, (2) communication issues, (3) supporting the need for control, (4) accompanying in the fight culture and (5) the extent of the need for care. A sixth theme was also added in order to report the need expressed by nurses to improve their care of patients living with ALS at end-of-life. Conclusions: Although nurses' experiences varied among the different settings, the study identifies the pressing need for better education and, above all, more resources when caring for a person living with ALS at end-of-life. Future research should explore the experiences of other members of the healthcare team and test interventions designed to improve the quality of life and end-of-life of people living with ALS.

Unlicensed assistive personnel's involvement in delivering care to persons with or at risk of delirium: a scoping review protocol.

OBJECTIVE: The objective of this review is to describe the nature and extent of the literature regarding unlicensed assistive personnel's involvement in delivering care to persons with or at risk of delirium. INTRODUCTION: Initiatives that promote the involvement of unlicensed assistive personnel in providing additional supervision and care to persons with or at risk of delirium have been developed. Because no standardized approach guides unlicensed assistive personnel's involvement with persons with or at risk of delirium, and because inconsistent training and expectations may pose a threat to the safety and quality of care, it is essential to clarify the role of unlicensed assistive personnel in caring for persons with or at risk of delirium. INCLUSION CRITERIA: This review will consider articles published in peer-reviewed journals, dissertations, theses, book chapters, and conference papers. Quantitative, qualitative, or mixed methods studies that report on the development, implementation, or evaluation of the role of unlicensed assistive personnel in contexts of delirium will be included. We will consider editorials and opinion papers only if they report on the development, implementation, or evaluation of the role of unlicensed assistive personnel. METHODS: Records published in French or English will be identified via CINAHL, ProQuest Dissertations & Theses Global, Embase, MEDLINE, APA PsycINFO, and Web of Science. Two independent reviewers will select studies and extract data using a piloted form. Data will be synthesized narratively, using descriptive statistics and a tabular format. A consultation phase will include approximately 24 unlicensed assistive personnel and registered nurses who will be invited to comment on the review findings. KEY DETAILS OF THIS REVIEW PROJECT ARE AVAILABLE IN OPEN SCIENCE FRAMEWORK: https://osf.io/kg9yx/.

Application of the Person-Centered Care to Manage Responsive Behaviors in Clients with Major Neurocognitive Disorders: A Qualitative Single Case Study.

OBJECTIVES: Our study aimed to describe "how" and "why" the person-centered care (PCC) approach was applied within a long-term care (LTC) community to manage responsive behaviors (RBs) in individuals with major neurocognitive disorders. METHODS: A descriptive holistic single case study design was employed in the context of an LTC community in Quebec, using semi-structured interviews and non-participatory observations of experienced care providers working with clients with RBs, photographing the physical environment, and accessing documents available on the LTC community's public website. A thematic content analysis was used for data analysis. RESULTS: The findings generated insight into the importance of considering multiple components of the LTC community to apply the PCC approach for managing RBs, including a) creating a homelike environment, b) developing a therapeutic relationship with clients, c) engaging clients in meaningful activities, and d) empowering care providers by offering essential resources. CONCLUSIONS: Applying and implementing the PCC approach within an LTC community to manage clients' RBs is a long-term multi-dimensional process that requires a solid foundation. CLINICAL IMPLICATIONS: These findings highlight the importance of considering multiple factors relevant to persons, environments, and meaningful activities to apply the PCC approach within LTC communities to manage RBs.

Disruptions in Relational Continuity: The Impact of Pandemic Public Health Measures on Families in Long-Term Care.

Although the value of family caregivers' involvement with relatives in long-term care (LTC) is well recognized, tensions remain regarding their role. Such tensions were exacerbated during the COVID-19 pandemic as strict public health measures restricted family access to LTC homes. Using interpretive description, we examined the impact of visitation restrictions on family caregivers' experiences caring for a relative in LTC between March 2020 and June 2021. In-depth interviews were conducted with 14 family caregivers (five spouses and nine adult daughters) and two key themes were identified. The first theme, "seeking to maintain relational continuity," illustrates how caregivers sought to sustain connections with residents prior to and during the pandemic. The second theme, "disrupted relational continuity," highlights the impact of severed relational connections on caregivers' sense of self and ongoing feelings of loss and anger. Findings call for a trauma-informed approach that recognizes the pervasiveness of trauma for family caregivers and the avoidance of re-traumatization.

Designing, planning, and conducting systematic reviews and other knowledge syntheses: Six key practical recommendations to improve feasibility and efficiency.

BACKGROUND: Knowledge syntheses, such as systematic reviews, scoping reviews, and realist reviews, are crucial tools to guide nursing practice, policy, and research. However, conducting high-quality knowledge syntheses is a complex and time-consuming endeavor. It is imperative for nursing students, clinicians, and researchers to be aware of key practical recommendations regarding the conduct of knowledge syntheses to improve the feasibility and efficiency of such projects. AIM: The aim of this paper was to discuss key practical recommendations for designing, planning, and conducting knowledge syntheses relevant to nursing policy, practice, and research. METHODS: The recommendations discussed are based on best-practice guidance about knowledge synthesis methodology proposed by The Campbell Collaboration (Campbell systematic reviews: Policies and guidelines, 2020), Cochrane (Cochrane training, 2019), and the Joanna Briggs Institute (The Joanna Briggs Institute reviewers' manual, 2020) and on strategies used by the authors to improve the feasibility and efficiency of knowledge syntheses. RESULTS: This paper highlights six key practical recommendations that nursing students, clinicians, and researchers should take into account when deciding to embark on a knowledge synthesis project: (1) determining if (and why) knowledge synthesis should be conducted; (2) selecting the appropriate type of knowledge synthesis, as well as the associated methodological guidance and reporting standards; (3) developing a search strategy that balances sensitivity and specificity; (4) writing a protocol and obtaining feedback; (5) determining the resources required to conduct the different stages of the knowledge synthesis; and (6) keeping an audit trail. Fifteen common types of knowledge synthesis are presented with their definitions, relevant methodological guidance, and reporting standards. LINKING EVIDENCE TO ACTION: The recommendations discussed, used in conjunction with appropriate methodological guidelines, may help ensure the success of a knowledge synthesis project by providing best-practice and experience-based guidance to newcomers in the field.

Existing eHealth Solutions for Older Adults Living With Neurocognitive Disorders (Mild and Major) or Dementia and Their Informal Caregivers: Protocol for an Environmental Scan.

BACKGROUND: Dementia is one of the main public health priorities for current and future societies worldwide. Over the past years, eHealth solutions have added numerous promising solutions to enhance the health and wellness of people living with dementia-related cognitive problems and their primary caregivers. Previous studies have shown that an environmental scan identifies the knowledge-to-action gap meaningfully. This paper presents the protocol of an environmental scan to monitor the currently available eHealth solutions targeting dementia and other neurocognitive disorders against selected attributes. OBJECTIVE: This study aims to identify the characteristics of currently available eHealth solutions recommended for older adults with cognitive problems and their informal caregivers. To inform the recommendations regarding eHealth solutions for these people, it is important to obtain a comprehensive view of currently available technologies and document their outcomes and conditions of success. METHODS: We will perform an environmental scan of available eHealth solutions for older adults with cognitive impairment or dementia and their informal caregivers. Potential solutions will be initially identified from a previous systematic review. We will also conduct targeted searches for gray literature on Google and specialized websites covering the regions of Canada and Europe. Technological tools will be scanned based on a preformatted extraction grid. The relevance and efficiency based on the selected attributes will be assessed. RESULTS: We will prioritize relevant solutions based on the needs and preferences identified from a qualitative study among older adults with cognitive impairment or dementia and their informal caregivers. CONCLUSIONS: This environmental scan will identify eHealth solutions that are currently available and scientifically appraised for older adults with cognitive impairment or dementia and their informal caregivers. This knowledge will inform the development of a decision support tool to assist older adults and their informal caregivers in their search for adequate eHealth solutions according to their needs and preferences based on trustable information. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41015.

Holistic Health Practices of Rural Thai Homebound Older Adults: A Focused Ethnographic Study.

INTRODUCTION: Supporting independent functioning of homebound, chronically ill older adults (HOAs) is a major concern across cultures. In Thailand, actions HOAs take to remain independent and maintain their holistic (mental, physical, and spiritual) health is understudied. Therefore, we explored self-care practices used by rural Thai HOAs to maintain their independence. METHODS: We used a focused ethnographic approach, recruiting HOAs, their families, and community members from a rural area in Southern Thailand. Data were analyzed using content analysis. RESULTS: Sixteen HOAs and 23 family/community members participated. Three themes emerged: self-care to stay healthy, sharing life with family and society in a positive way, incorporating both folk and modern medicine to maintain health. Factors facilitating holistic health practices were supportive family network, Thai cultural beliefs, community strength and support, and health care services. DISCUSSION/CONCLUSIONS: These findings may help health care professionals develop interventions supporting holistic health practices of Thai HOAs to remain independent.

How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review.

BACKGROUND: Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). METHODS: We conducted a scoping review by searching multiple databases from 2000 inclusive to June 7, 2020. We extracted data on study characteristics and PCCS approaches, evaluation, determinants or the impact of strategies to implement PCCS. We used summary statistics to report data and interpreted findings with an existing person-centred care framework. RESULTS: We included 22 studies with qualitative (55%) or quantitative/multiple methods design (45%) involving affected persons (50%), or healthcare workers (50%). Studies varied in how PCCS was conceptualized; 59% cited a PCC definition or framework. Affected persons and healthcare workers largely agreed on what constitutes PCCS (e.g. foster partnership, promote autonomy, support carers). In 4 studies that evaluated care, barriers of PCCS were reported at the affected person (e.g. family conflict), healthcare worker (e.g. lack of knowledge) and organizational (e.g. resource constraints) levels. Studies that evaluated strategies to implement PCCS approaches were largely targeted to healthcare workers, and showed that in-person inter-professional educational meetings yielded both perceived (e.g. improved engagement of affected persons) and observed (e.g. use of PCCS approaches) beneficial outcomes. Few studies reported results by gender or other intersectional factors, and none revealed if or how to tailor PCCS for women. This synthesis confirmed and elaborated the PCC framework, resulting in a Framework of PCCS for Dementia. CONCLUSION: Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture.

Inclusion of informal caregivers in the palliative and end-of-life care of older adults: a scoping review protocol.

INTRODUCTION: Palliative and end-of-life (EOL) care will increasingly be required in years to come as a result of an ageing population. An important component of this type of care is the inclusion of informal caregivers, who are family members or friends offering unpaid assistance to older adults with a terminal illness. Although systematic reviews were conducted on topics related to the inclusion of informal caregivers in the palliative and EOL care of older adults, several gaps remain as they were specific to a health condition and/or setting. The purpose of our scoping review is to map the extent of knowledge on this subject. METHODS AND ANALYSIS: We will conduct our scoping review following Levac's methodology. We will gather publications of various types through nine databases, manual searches in journals and search engines and reference lists. The selection process will be conducted by two independent reviewers and consist of screening by title and abstract, followed by reading the full text to confirm eligibility. An independent reviewer will then extract data and assess quality from included publications. Data extracted from different publication types will be synthesised together in the Excel software using a content analysis method, with quantitative data transformed into a qualitative description. Results will be presented through descriptive statistics and themes. During different steps of the review, we will also consult informal caregivers and health professionals for feedback as stakeholders. ETHICS AND DISSEMINATION: The conduction of this scoping review requires no ethical approval. Results will provide an overview of the state of knowledge on the inclusion of informal caregivers in palliative and EOL of older adults, which could help guide clinical practice, the development of interventions and policy and further research. We will disseminate these results by publishing an article, presenting in conferences, and discussing findings with stakeholders.

The development of the MENTOR_D nursing intervention: Supporting family involvement in delirium management.

BACKGROUND: Although families are increasingly seen as allies to improve delirium management and reduce its consequences, their involvement in the postcardiac surgery setting is challenging considering patients' critical state and short hospital stay. To our knowledge, no theory-based nursing intervention exists that optimally supports the involvement of families in delirium management in the context of postcardiac surgery. OBJECTIVES: We aimed to develop MENTOR_D, a nursing intervention to support the involvement of families in delirium management. METHODS: MENTOR_D was developed based on Sidani and Braden's (2011) intervention development framework. Narrative literature reviews paired with the clinical experience of an expert committee were used to inform these three steps: (1) develop an understanding of the problem under study; (2) define the objectives of the intervention and identify a theoretical framework for highlighting strategies to be used in the intervention; and (3) operationalize the intervention and identify its anticipated outcomes. RESULTS: As a result of the three steps, the MENTOR_D nursing intervention relies on a caring-mentoring relationship between a nurse and the family. The aim of MENTOR_D is to increase the presence of the family at their relative's bedside and their involvement in delirium management. MENTOR_D's content is delivered over three phases that are organised around the visits of the family at the patient's bedside. During these phases, families used their knowledge of the patient to tailor the delirium management actions. These actions include orientation and reminiscence and were aimed at diminishing anxiety and increasing sense of self-efficacy in families and diminishing delirium severity and improving recovery in patients. CONCLUSIONS: A deep understanding of the underlying mechanisms of an intervention is key in its success to reach the targeted goals of effectiveness in practice. This understanding can be achieved through the careful development of a theory of the intervention before the operationalisation of its components and its testing. The proposed paper presents the theory of the MENTOR_D intervention, that is, its conceptualization and proposed mechanisms of action. IMPLICATIONS FOR PRACTICE: As delirium continues to be a major complication, this intervention is a promising solution to increase families' involvement in delirium management and highlights the support that nurses can offer to facilitate this involvement. With its use in future studies and practice, it can be further refined.

Determinants of technology adoption and continued use among cognitively impaired older adults: a qualitative study.

BACKGROUND: Technology offers opportunities to support older adults with mild cognitive impairments to remain independent and socially connected, but is often not used. Although determinants of technology use among older adults in general are well studied, much less is known about how these factors impact technology use behaviour in cognitively impaired older adults. This study aimed to bridge this gap in research by examining the factors underlying technology use in community-dwelling older adults with mild cognitive impairments. METHODS: We applied a generic qualitative design and used 16 semi-structured interviews to collect data from Belgian (Flemish) community-dwelling older adults diagnosed with Mild Cognitive Impairment or dementia and informal caregivers. To get data from different perspectives, a focus group with professional caregivers was added. We used thematic analysis with an inductive approach to identify and select themes from the data. RESULTS: We identified two themes: introduction of technology and determinants of technology adoption and continued use. Successful technology adoption in cognitively impaired older adults is need-driven and subject to individual, technological and contextual characteristics. Specific for older adults with cognitive impairments are the importance of disease awareness and cognitive ability for adoption and continued use, respectively. Although social support can be a valuable alternative to technology, it is an important facilitator of continued technology use in these older adults. Similarly, integration of technologies in daily routines can buffer discontinuation of technologies. CONCLUSIONS: Future research is encouraged to validate our findings in a postpandemic era and to further develop a novel theoretical framework for technology acceptance among older adults with cognitive impairments. Moreover, identification of crucial determinants as well as strategies to remove use barriers are also important future research tasks. Clinical practice should focus on improving disease awareness to facilitate technology adoption and policies should invest in training and support of professional caregivers and in reimbursement strategies to facilitate implementation of technology in practice.

What will happen to my mom? A grounded theory on nurses' support of relatives' end-of-life decision-making process for residents living with dementia in long-term care homes.

BACKGROUND: Relatives of an older person living in a long-term care home with advanced-stage dementia must often make important and difficult decisions, including ones that impact the resident's end-of-life. Healthcare professionals must support them in this decision-making process. The aim of this study was to propose a theory on nurses' support of relatives who make end-of-life decisions for a resident living with dementia in a long-term care home. METHOD: A constructivist grounded theory approach was used, with a theoretical sample of nine nurses and 10 relatives whom we met for face-to-face interviews. Three documents on end-of-life care, which were available in the study setting, were also included. The analysis was carried out using the method proposed by Charmaz. FINDINGS: The findings highlight the importance of building a strong and trusting relationship between nurses and relatives. Furthermore, exploring the refusal of palliative or end-of-life care, supporting relatives' need to witness firsthand the condition of the person living with dementia, and education at a "good" time are useful interventions that nurses can make to support relatives' decision-making. CONCLUSION: Better support of relatives in end-of-life decision-making improves the well-being of relatives and older people living with dementia alike.

Les comportements des personnes âgées vivant avec un trouble neurocognitif : l'approche centrée sur les relations pour améliorer l'expérience de tous.

Older people living with a major neurocognitive disorder often have difficulty communicating. They may exhibit reactive behaviors, such as vocal or aggressive behaviors, which are manifestations of malaise. These behaviors have consequences for these older people, as well as for their relatives and formal caregivers. This article discusses the relationship-centered approach to improving the experience of each of these persons by stimulating a reflection on what unites us. Then, the principles of this relationship-centered approach are outlined, based on the unique needs of each person, the reciprocity of their relationship, and their common aspirations. The application of these principles to older people living with a neurocognitive disorder who exhibit reactive behaviors is reflected through the adoption of consistent language, the identification of the meanings of behaviors and personalized actions, and the establishment of a care partnership. An example of a process integrating this approach is presented, as well as its possible effects. The adoption of this approach may present several challenges in care settings. To meet these challenges, implementation strategies are described promoting the adoption of this approach and contributing to everyone’s well-being.

"Bai Lod" holistic health experienced by homebound older people in the southern Thai community.

OBJECTIVES: This qualitative descriptive study aims to explore the meanings of holistic health in the southern Thai culture experienced by homebound older people. BACKGROUND: The ageing society necessitates many services to meet the holistic needs of older people. Homebound older people are commonly an understudied population who may view their holistic health and well-being differently from others. Due to geographical differences and local Thai cultural context, exploring the holistic health in the southern Thai culture would help promote a healthy lifestyle and improve their health outcomes. METHODS: Based on purposeful sampling, 16 key informants who were homebound older people (ages ≥ 60 years old) living at home in a rural southern Thai community were participated in semi-structured interviews. Informants consisted of six males and ten females who were Buddhist and married. Their ages ranged from 79 to 99, including nine homebound older people who lived in a couple, and seven widows and widowers. Eight had completed the primary school, and others were uneducated. The data were analysed with a content analysis. RESULTS: Most of the informants had chronic diseases. In a broad main theme, the informants described the holistic health in local context as 'Bai Lod; which means being alive with positive, active and independent functioning. This theme included three sub-themes: self-supporting or taking care of themselves, having the ability to control their health conditions and being proud as a healthy older adult. The older people described self-supporting as the ability to perform their activities of daily living, take care of their own health and work independently (active living). Having the ability to control their health conditions meant functioning well physically, although being frail, by maintaining their health through self-management, and having a good mental health during such a life-changing situation. Older people valued the ability to live by themselves without being a burden to their family. They felt happy with their life. CONCLUSION: Holistic health was described as being positive and active at home, and influenced by beliefs and values related to good physical function, mental health and spiritual activities. These findings could help healthcare professionals better understand older people' health, well-being and cultural care in order to develop alternative strategies to maintain, enhance and support an active life for homebound older people.

The Effectiveness of e-Health Solutions for Aging With Cognitive Impairment: A Systematic Review.

BACKGROUND AND OBJECTIVES: e-Health solutions are an innovative approach to support aging with cognitive impairment. Because technology is developing at a fast pace, the aim of this review was to present an overview of the research regarding the effectiveness of these solutions. Moreover, the availability of these solutions was examined. RESEARCH DESIGN AND METHODS: Systematic searches were conducted in 7 databases. Full texts of potentially relevant references were assessed by 2 reviewers, and discrepancies were solved through discussion. Data on study characteristics, technology type, application domain, availability, outcomes, and effects were extracted. A categorization exercise and narrative synthesis were conducted. RESULTS: In total, 72 studies describing 70 e-Health solutions were identified. The majority of solutions comprised cognitive training for older adults, followed by educational and supportive web platforms for caregivers. Outcomes included mainly measures of cognition, psychosocial functioning, caregiving processes, caregiver-care receiver relationship, and activities of daily living. Positive effects of cognitive training technologies were observed on cognitive functioning of older adults, as well as those of supportive web platforms on behavioral and psychological symptoms of dementia and caregiver self-efficacy. The effects of these solutions on depression in both target groups were inconclusive. The methodological quality of the studies was moderate to good. However, some important limitations were observed. DISCUSSION AND IMPLICATIONS: The review identified cognitive training solutions and supportive web platforms as the most effective on a limited number of outcomes. Although other solutions seem promising, further research has to overcome methodological issues. Furthermore, solutions for leisure and reminiscence and outcomes specifically related to independent living deserve more attention.

e-Health interventions for healthy aging: a systematic review.

BACKGROUND: Healthy aging (HA) is a contemporary challenge for population health worldwide. Electronic health (e-Health) interventions have the potential to support empowerment and education of adults aged 50 and over. OBJECTIVES: To summarize evidence on the effectiveness of e-Health interventions on HA and explore how specific e-Health interventions and their characteristics effectively impact HA. METHODS: A systematic review was conducted based on the Cochrane Collaboration methods including any experimental study design published in French, Dutch, Spanish, and English from 2000 to 2018. RESULTS: Fourteen studies comparing various e-Health interventions to multiple components controls were included. The target population, type of interventions, and outcomes measured were very heterogeneous across studies; thus, a meta-analysis was not possible. However, effect estimates indicate that e-Health interventions could improve physical activity. Positive effects were also found for other healthy behaviors (e.g., healthy eating), psychological outcomes (e.g., memory), and clinical parameters (e.g., blood pressure). Given the low certainty of the evidence related to most outcomes, these results should be interpreted cautiously. CONCLUSIONS: This systematic review found limited evidence supporting the effectiveness of e-Health interventions, although the majority of studies show positive effects of these interventions for improving physical activity in older adults. Thus, better quality evidence is needed regarding the effects of e-Health on the physiological, psychological, and social dimensions of HA. SYSTEMATIC REVIEW REGISTRATION: The review protocol was registered in PROSPERO (registration number: CRD42016033163).

An Action Research to Optimize the Well-Being of Older People in Nursing Homes: Challenges and Strategies for Implementing a Complex Intervention.

Few studies have been conducted on strategies to promote the implementation of complex interventions in nursing homes (NHs). This article presents a pilot study intended to assess the strategies that would enable the optimal implementation of a complex intervention approach in NHs based on the meanings of screams of older people living with Alzheimer's disease. An action research approach was used with 19 formal and family caregivers from five NHs. Focus groups and individual interviews were held to assess different implementation strategies. A number of challenges were identified, as were strategies to overcome them. These latter included interactive training, intervention design, and external support. This study shows the feasibility of implementing a complex intervention to optimize older people's well-being. The article shares strategies that may promote the implementation of these types of interventions in NHs.