The transition of care from farm-based daycare for people with dementia: The perspective of next of kin.

PURPOSE: The aim of the present study was to explore the next of kin's experiences with the transition for people with dementia from a farm-based daycare (FDC) to another service in the municipality. METHODS: The study has a qualitative, descriptive design. Eight semi-structured interviews with next of kin were conducted. The data were analysed in accordance with content analysis. RESULTS: Through the analysis three main categories were developed: (1) Bearing the burden, (2) Being in transition, and (3) Feeling supported. The transition period was highly stressful for next of kin due to the exacerbation of their relatives' dementia symptoms. The next of kin focussed on optimizing the everyday lives of their relatives with dementia, even at the expense of their own well-being. Most participants experienced support from FDC, healthcare services and their informal network. CONCLUSIONS: The study contributes important insights into the next of kin's experiences. Good quality service, close dialog, information, and support between the different part in the transition process, can be useful for the further development of services with good quality and to reduce the negative effects of care on next of kin.

Emotional well-being in people with dementia - A comparative study of farm-based and regular day care services in Norway.

There is a focus on how to provide care for the increasing number of people with dementia, and day care services have been highlighted as an important service. The present study aims to provide an in-depth comparison of the emotional well-being of participants at farm-based and regular day care services related to different aspects of the care environments. We used the Maastricht Electronic Daily Life Observation-tool to observe and register aspects of the care environment at the services. Observations took place at ten farm-based day care services, with 42 participants, and seven regular day care centres, with 46 participants. Observed mood was considered an indicator for the emotional well-being of the participants and used as the primary outcome. The analyses showed a general positive mood for all participants, regardless of type of day care service. The unadjusted analyses showed more emotional well-being for the participants at farm-based day care across a range of factors compared to regular day care. The linear mixed model found that regardless of service type the activities (1) exercise and dancing, and (2) quiz, music and spiritual activities were associated with emotional well-being. In addition, social interaction, either with one person or two or more people, were also associated with emotional well-being regardless of service type. The mixed model further demonstrated an association between attending farm-based day care services and positive mood compared to regular day care services. Based on the findings social interaction and social activities seem important to emotional well-being. This highlights the social aspect of the day care services and future research should investigate how one can facilitate good social interactions at day care services. The positive association between farm-based day care services and emotional well-being may potentially reflect a positive influence of the farm setting and the farm service providers.

Being sheltered from a demanding everyday life: experiences of the next of kin to people with dementia attending farm-based daycare.

PURPOSE: Farm-based daycare (FDC) is a type of daycare service for people with dementia. The aim of the present study was to explore the next of kin's experiences with FDC and how the service may affect their daily life. METHODS: The study has a qualitative, descriptive design. Eight semi-structured interviews with next of kin were conducted. The data were analysed in accordance with content analysis. RESULTS: We identified three main categories: (1) I am fine when you are fine, (2) Significant aspects of the service at the farm, and (3) FDC as a part of the dementia trajectory. The findings were summarized in one overarching, latent theme: "Being sheltered from a demanding everyday life". CONCLUSIONS: The findings indicate that next of kin's experience of respite is closely connected to the well-being of their relatives at the FDC and the quality of the service. FDC provides significant support through a part of the trajectory of dementia. Despite experiencing respite and support, next of kin continue to struggle with ethical and moral decisions about the futures of their relatives with dementia.

Effects on sleep from group activity with a robotic seal for nursing home residents with dementia: a cluster randomized controlled trial.

OBJECTIVES: Sleep disturbances are common in people with dementia and increase with the severity of the disease. Sleep disturbances are complex and caused by several factors and are difficult to treat. There is a need for more robust and systematic studies dealing with sleep disturbances in older people with dementia. The aim of this study was to investigate effects from robot-assisted (Paro) group activity on sleep patterns in nursing home (NH) residents with dementia. DESIGN: A cluster randomized controlled trial. SETTING: Special care units in 10 NH in Norway. PARTICIPANTS: A total of 60 participants over 65 years with dementia were recruited. Thirty participants were recruited to the intervention group and 30 participants to the control group. INTERVENTION: Participants participated in group activity with Paro for 30 minutes twice a week over 12 weeks or in control group (treatment as usual). MEASUREMENTS: Sleep-wake patterns were assessed objectively by 7 days of wrist actigraphy before and after the intervention. Data were collected between March 2013 and September 2014. Data were analyzed using mixed models. RESULTS: Positive effects on change in sleep were found in the intervention group as compared with the control group. The intervention group increased percentage of sleep efficiency, increased the amount of total sleep time and reduced number of nocturnal awakenings. In addition, a significant effect was found in reduced awakenings after sleep onset. CONCLUSIONS: Social stimulation through engaging group activity could contribute to improved sleep in people with dementia in NH. Increased sleep efficiency and total sleep time, in addition to fewer night awakenings, affect central indicators of good sleep quality across the life span. Improved sleep quality will also affect quality of life and comorbidities in vulnerable groups. We believe group activity with Paro to be an accessible and feasible non-pharmacological treatment for those who enjoy Paro.

Comparing the care environment at farm-based and regular day care for people with dementia in Norway-An observational study.

People with dementia should be able to live in the community, and day care services are recommended as a means for people to live in their own homes for as long as possible. In this study we wanted to compare the quality of care at one type of small-scale day care situated at community farms to regular day care provided in connection with residential care facilities for elderly people. A total of 42 participants from 10 farm-based day care offers and 46 participants from seven regular day care offers were included. A qualitative observational design using the validated Maastricht Electronic Daily Life Observation tool was used. The data were collected between March and June 2018. Ecological momentary assessments of the activities taking place, level of engagement, physical effort, location, social interaction and mood were conducted while the participants attended their day care offer. The results showed that familiar daily activities were common at farm-based day care, and a linear mixed model analysis showed that farm-based day care attendees used more physical effort, spent more time outdoors, had more social interaction and experienced more positive mood compared to regular day care attendees. These findings contribute with valuable information about care provided at different types of day care services, and indicate that farm-based day care has more activities with the potential to meet the social and activity needs of people with dementia compared to regular day care. There are two main implication of this study. First, regular day care services should focus on including more familiar daily activities found to be important for attendees' sense of identity and feelings of contributing. Second, regular day care services should utilise the potential of available outdoor areas as time spent outdoors has been found to facilitate physical activity, relaxation, health and well-being.

Characteristics, Burden of Care and Quality of Life of Next of Kin of People with Dementia Attending Farm-Based Day Care in Norway: A Descriptive Cross-Sectional Study.

PURPOSE: Caring for people with dementia is often associated with burden of care and may influence the quality of life of the next of kin. The aim of this study was to describe the characteristics of the next of kin to people with dementia attending farm-based day care service (FDC) and identify characteristics associated with burden of care and quality of life (QoL) of next of kin. PARTICIPANTS AND METHODS: Ninety-four dyads of people with dementia and their next of kin were included from 25 FDCs in Norway in this descriptive cross-sectional study. The Relative Stress Scale (RSS) and the QoL-Alzheimer's Disease Scale (QoL-AD) were used as outcomes measures. RESULTS: The participants consisted of those who lived with a person with dementia (spouse/partner, 62%) and those who did not (children), with significant differences in age, education level, work employment, perceived social support, depression symptoms, burden of care, and QoL. In multiple regression models, RSS and QoL were associated with living with the person with dementia, anxiety symptoms and perceived social support. In addition, RSS was associated with neuropsychiatric symptoms (NPS) in the people with dementia. CONCLUSION: Our findings underline the importance of obtaining knowledge about the next of kin's burden of care and QoL, of people with dementia attending an FDC. This knowledge is essential for those responsible for providing the best possible services for the next of kin and for developing targeted interventions to support the next of kin.

Data on initial leaf P concentrations and final dry matter yields of silage maize in response to row-injected cattle slurry.

This article displays a dataset obtained in a field trial conducted in 2016 on a sandy loam and a coarse sandy soil, Denmark. Leaf phosphorus (P) and nitrogen (N) concentrations at the five-leaf stage (V5) and final dry matter (DM) yields of silage maize were determined in response to seven treatments with placed slurry below the maize row. Two row-injection methods combined with slurry acidification or addition of a nitrification inhibitor were tested. Furthermore final crop P uptake and P surplus at field level were determined. This dataset can be used to assess the effect of placed slurry with or without slurry acidification and addition of a nitrification inhibitor on silage maize yields and to enhance our knowledge on maize P uptake and P surpluses at field level. In turn this can support the design of appropriate row-injection machinery of slurry. The data supplied in this article is related to the research article entitled "Row-injected cattle slurry can replace mineral P starter fertiliser and reduce P surpluses without compromising final yields of silage maize" [1], where results from 2017 and 2018 are presented and discussed. The trials in 2016, 2017 and 2018 were conducted on the same study sites. The experimental design in 2017 and 2018 was a full-factorial design and did also include reference treatments with evenly injected slurry, whereas these reference treatments were not included in the present article.

Care Farming for People with Dementia; What Can Healthcare Leaders Learn from This Innovative Care Concept?

There is growing recognition that traditional dementia care models fall short for people with dementia and their family caregivers. This has led to a call for new dementia care approaches. In response to this call, innovations in long-term dementia care are taking place both in the community and in residential care. One of these innovations is the care concept called "care farming." Care farms are farms that combine agricultural activities with care and support services for a variety of client groups, including people with dementia. Although the concept is being implemented in an increasing number of countries, the Netherlands and Norway are still front-runners in providing and researching this innovative dementia care approach. Over the last couple of years, several research projects have been carried out in these countries addressing a wide range of issues related to dementia care provision at care farms and using a wide range of research methods. This paper synthesizes the knowledge that has been generated in these research projects. By sharing the knowledge obtained in the Netherlands and Norway, we hope to inspire leaders in healthcare undertaking similar efforts to innovate care for the increasing number of people with dementia. By providing starting-points for future research, we additionally hope to contribute to a research agenda to further advance the field.

Farm-based day care services - a prospective study protocol on health benefits for people with dementia and next of kin.

INTRODUCTION: The increasing number of people with dementia will place a considerable challenge on the health care system and will necessitate innovation and new solutions. Day care services aim to provide meaningful activities and coping experiences for the target group. The aim of the present study is to explore the experience and potential health benefits for people with dementia attending farm-based day care services in Norway and their next of kin. METHODS AND DESIGN: The present study is a prospective study organized into several qualitative and quantitative sub-studies. Study period will last from 2016-2020. We use a multi-method approach and both an empirical and a constructivist view on knowledge to explore this multi-facetted phenomenon. DISCUSSION: Several challenges are expected, for instance, the ability to include participants with dementia and keep them within the study for the whole study period. The functioning level of participants regarding language and understanding could challenge their ability to answer. Despite having several limitations, we believe that this study with its different approaches and methods will add important knowledge to the field. Knowledge from our study could be essential for creating day care services of good quality for people with dementia and such services could reduce the burden of care for their next of kin.

Newly depolymerized large organic N contributes directly to amino acid uptake in young maize plants.

The contribution of large molecular size organic nitrogen (N) to plant N uptake is unclear. Soils with and without maize, at three pH levels, were treated with (carbon-14 and -13 (14 C, 13 C), 15 N) triple-labelled > 100 kDa organic N. After 48 h, soil and maize were sampled for bulk and compound specific isotope analysis to study the turnover in soil and plant 13 C and 15 N uptake. Mineralization of > 100 kDa organic N increased with higher pH only in soil without maize. The > 100 kDa organic N disappeared rapidly in soils with and without maize, but surprisingly more > 100 kDa organic N derived amino acids remained in soil with than without maize - most likely in the microbial biomass. Total 15 N uptake in maize increased with higher soil pH. The organic N uptake was estimated to account for 20-30% of the total 15 N uptake. Organic N uptake was confirmed by the presence of 13 C-labelled amino acids in maize roots. The study suggests that the importance of plant organic N uptake increases when N is derived from complex molecules such as proteins compared to studies using single amino acids as N source, and that rhizosphere microorganisms increase anabolic utilization of organic N compared to microorganisms in the bulk soil.

Engagement in elderly persons with dementia attending animal-assisted group activity.

The need for meaningful activities that enhance engagement is very important among persons with dementia (PWDs), both for PWDs still living at home, as well as for PWDs admitted to a nursing home (NH). In this study, we systematically registered behaviours related to engagement in a group animal-assisted activity (AAA) intervention for 21 PWDs in NHs and among 28 home-dwelling PWDs attending a day care centre. The participants interacted with a dog and its handler for 30 minutes, twice a week for 12 weeks. Video-recordings were carried out early (week 2) and late (week 10) during the intervention period and behaviours were categorized by the use of an ethogram. AAA seems to create engagement in PWDs, and might be a suitable and health promoting intervention for both NH residents and participants of a day care centre. Degree of dementia should be considered when planning individual or group based AAA.

Change in quality of life in older people with dementia participating in Paro-activity: a cluster-randomized controlled trial.

AIM: The aim of this study was to investigate effects of robot-assisted group activity with Paro on quality of life in older people with dementia. BACKGROUND: Nursing home residents with severe dementia often experience social withdrawal and lower quality of life, which are suggested to be enhanced by non-pharmacological interventions. DESIGN: A cluster-randomized controlled trial. Ten nursing home units were randomized to robot-assisted intervention or control group (treatment as usual). METHODS: Data were collected between March 2013-September 2014. 27 participants participated in group activity for 30 minutes twice a week over 12 weeks, 26 participated in the control group. Change in quality of life was assessed by local nurses through the Quality of Life in Late-Stage Dementia scale at baseline, after end of intervention and at 3 months follow-up. The scale and regular psychotropic medication were analysed stratified by dementia severity. Analysis using mixed model, one-way anova and linear regression were performed. RESULTS: An effect was found among participants with severe dementia from baseline to follow-up showing stable quality of life in the intervention group compared with a decrease in the control group. The intervention explained most of the variance in change in the total scale and in the subscales describing Tension and Well-being for the group with severe dementia. The intervention group used significantly less psychotropic medication compared with the control group after end of intervention. CONCLUSION: Pleasant and engaging activities facilitated by nursing staff, such as group activity with Paro, could improve quality of life in people with severe dementia. The trial is in adherence with the CONSORT statement and is registered at www.clinicaltrials.gov (study ID number: NCT01998490) [corrected].

Differences in quality of life in home-dwelling persons and nursing home residents with dementia - a cross-sectional study.

BACKGROUND: Dementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time. METHODS: The cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data. RESULTS: Home-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However, only residency contributed significantly in the model. Residency also significantly predicted negative change over time in QoL. CONCLUSION: The study indicated that living at home as long as possible is not only desirable for economic or health political reasons but also is associated with higher QoL for persons with moderate dementia. More studies are needed to investigate how QoL could be increased for PWDs in nursing homes.

Effect of animal-assisted activity on balance and quality of life in home-dwelling persons with dementia.

UNLABELLED: Purpose of the study was to examine if animal-assisted activity with a dog (AAA) in home-dwelling persons with dementia (PWDs) attending day-care centers would have an effect on factors related to risk of fall accidents, with balance (Berg balance scale) and quality of life (Quality of Life in Late-stage Dementia) as main outcome. The project was conducted as a prospective and cluster-randomized multicenter trial with a follow-up. 16 adapted day-care centers recruited respectively 42 (intervention group) and 38 (control group with treatment as usual) home-dwelling PWDs. The intervention consisted of 30 min sessions with AAA led by a qualified dog handler twice a week for 12 weeks in groups of 3-7 participants. The significant positive effect on balance indicates that AAA might work as a multifactorial intervention in dementia care and have useful clinical implication by affecting risk of fall. TRIAL REGISTRATIONS: ClinicalTrial.gov; NCT02008630.

Group activity with Paro in nursing homes: systematic investigation of behaviors in participants.

BACKGROUND: A variety of group activities is promoted for nursing home (NH) residents with dementia with the aim to reduce apathy and to increase engagement and social interaction. Investigating behaviors related to these outcomes could produce insights into how the activities work. The aim of this study was to systematically investigate behaviors seen in people with dementia during group activity with the seal robot Paro, differences in behaviors related to severity of dementia, and to explore changes in behaviors. METHODS: Thirty participants from five NHs formed groups of five to six participants at each NH. Group sessions with Paro lasted for 30 minutes twice a week during 12 weeks of intervention. Video recordings were conducted in the second and tenth week. An ethogram, containing 18 accurately defined and described behaviors, mapped the participants' behaviors. Duration of behaviors, such as "Observing Paro," "Conversation with Paro on the lap," "Smile/laughter toward other participants," were converted to percentage of total session time and analyzed statistically. RESULTS: "Observing Paro" was observed more often in participants with mild to moderate dementia (p = 0.019), while the variable "Observing other things" occurred more in the group of severe dementia (p = 0.042). "Smile/laughter toward other participants" showed an increase (p = 0.011), and "Conversations with Paro on the lap" showed a decrease (p = 0.014) during the intervention period. CONCLUSIONS: Participants with severe dementia seemed to have difficulty in maintaining attention toward Paro during the group session. In the group as a whole, Paro seemed to be a mediator for increased social interactions and created engagement.

Understanding how prevocational training on care farms can lead to functioning, motivation and well-being.

PURPOSE: Prevocational training aims to improve basic vocational and social skills, supporting return to work for people who have been out of work for a long time. Care farms provide prevocational training; the aim of the study was to use the self-determination theory to gain an understanding of how these programmes can lead to healthy functioning and motivation for clients. METHOD: A total of 194 participants in prevocational training on care farms answered questions about demographic information, their perception of being a colleague, the social community on the farm, experiencing nature and animals and need satisfaction. A cross-sectional design resulting in a structural equation model was used to understand how elements of the care farm context influence satisfaction of three psychological needs. RESULTS: The results showed that a feeling of being a useful colleague led to competence, experiencing a sense of group belonging led to relatedness and autonomy, while receiving social support from the farmer led to satisfaction of all three needs for the participants. CONCLUSIONS: The results explain how prevocational training can stimulate participants' functionality, motivation and well-being. This understanding enables initiators and managers of prevocational training to understand and further strengthen the need-supportive elements of such programmes. Implications for Rehabilitation Prevocational training on care farms can facilitate motivation, functioning and well-being for clients. Making clients feel like useful colleagues that belong to a client group will strengthen the positive qualities of these programmes. Support, understanding and acknowledgement from the farmer are the most important elements for a positive development for the clients.

Effect of animal-assisted interventions on depression, agitation and quality of life in nursing home residents suffering from cognitive impairment or dementia: a cluster randomized controlled trial.

OBJECTIVES: The prevalence of neuropsychiatric symptoms in cognitively impaired nursing home residents is known to be very high, with depression and agitation being the most common symptoms. The possible effects of a 12-week intervention with animal-assisted activities (AAA) in nursing homes were studied. The primary outcomes related to depression, agitation and quality of life (QoL). METHOD: A prospective, cluster randomized multicentre trial with a follow-up measurement 3 months after end of intervention was used. Inclusion criteria were men and women aged 65 years or older, with a diagnosis of dementia or having a cognitive deficit. Ten nursing homes were randomized to either AAA with a dog or a control group with treatment as usual. In total, 58 participants were recruited: 28 in the intervention group and 30 in the control group. The intervention consisted of a 30-min session with AAA twice weekly for 12 weeks in groups of three to six participants, led by a qualified dog handler. Norwegian versions of the Cornell Scale for Depression, the Brief Agitation Rating Scale and the Quality of Life in Late-stage Dementia scale were used. RESULTS: A significant effect on depression and QoL was found for participants with severe dementia at follow-up. For QoL, a significant effect of AAA was also found immediately after the intervention. No effects on agitation were found. CONCLUSIONS: Animal-assisted activities may have a positive effect on symptoms of depression and QoL in older people with dementia, especially those in a late stage. Copyright © 2016 John Wiley & Sons, Ltd.

Content and key components of vocational rehabilitation on care farms for unemployed people with mental health problems: A case study report.

BACKGROUND: Mental health problems are a major cause for new disability grants in Norway. A variety of approaches in vocational rehabilitation is needed for this group. Green work is one such program that has been implemented at Norwegian care farms, which aims to promote health and support the transition from unemployment to working life. OBJECTIVE: To describe care farms in Norway and identify the presence of key components of such vocational programs. METHODS: In this case study, we used The Norwegian National Register of Care Farms to gain an overview of farms with vocational rehabilitation programs. Data consisted of written information from five farms' own web-site together with answers from a cross sectional questionnaire. Content about programs was systematically extracted by using national green work guidelines. RESULTS: Descriptions of care farm programs showed that key components outlined by the national guidelines for green work were present. These components were; (1) variety of work activities, (2) adaptation of work tasks, (3) the farmers' support and supervision, (4) experiencing nature, (5) enhanced structure in everyday life. CONCLUSION: The description of vocational programs on care farms in relation to these key components, gives a thorough understanding of the content and organization of such programs.

Mental health rehabilitation in a care farm context: A descriptive review of Norwegian intervention studies.

BACKGROUND: C are farming is a service developed at farms for promoting mental and physical health and is increasingly used in mental health rehabilitation in Norway. OBJECTIVE: This article aims to present a descriptive review of Norwegian intervention research on care farms that provide rehabilitation for people with mental health disorders. METHODS: This literature review applied a non-systematic search strategy: all articles in the field known to the authors were selected for inclusion. The selected studies were intervention studies that were conducted on farms in Norway, that used adult participants with mental health problems/disorders, and that reported outcome measures related to mental health. The studies and articles presented quantitative and/or qualitative data. RESULTS: The findings from the published articles report improvements to mental health problems, such as depression, anxiety, perceived stress, positive affect, rumination, and self-efficacy. Qualitative data describe a variety of positive experiences, such as improved coping ability, increased social support, and appreciation of the care farm activity. CONCLUSION: Participating in interventions on care farms positively influences mental health. Care farming may therefore be used as a supplementary approach in mental health rehabilitation, as it offers meaningful and engaging occupations and social inclusion.

Autonomy support and need satisfaction in prevocational programs on care farms: The self-determination theory perspective.

BACKGROUND: Mental health problems are leading causes for early and prolonged withdrawal from the workforce. Green work on care farms represents a prevocational training program intended to stimulate return to work for people with mental health problems. Research suggests that care farms may improve mental health, but there is still little knowledge of the subjective perspective of clients in green work programs. OBJECTIVE: To gain a deeper and broader understanding of the individual experiences of people with mental health problems participating in green work on care farms in Norway. METHODS: A hermeneutic phenomenological research design was applied. Ten semi-structured interviews were conducted. The self-determination theory (SDT) was adapted to gain a deeper understanding of the themes that emerged in the analysis process of the interviews. RESULTS: Five main themes materialize describing participants' experiences within the green work program. The main themes consist of (1) structure and flexibility, (2) understanding and acknowledgement, (3) guidance and positive feedback, (4) nature and animals, and (5) reflections on personal functioning and the future. CONCLUSION: The main themes identified indicate a high degree of autonomy support and need satisfaction within the care farm context, which according to SDT can facilitate good human functioning, and well-being.