Home living older adults' subjective perceptions, evaluation, and interpretations of various welfare technology: A systematic review of qualitative studies.

Objectives: This paper aims to map home-living older adults' subjective perceptions, evaluations, and interpretations of various welfare technologies. Study design: Systematic literature review. Methods: The study was designed as a systematic literature review of qualitative studies. This systematic literature review was carried out according to the PRISMA statement and was prospectively registered in PROSPERO registration number CRD42020190206. The international electronic bibliographic databases included AMED, Academic, CINAHL, Cochrane Reviews, EMBASE, Google Scholar, MEDLINE via PubMed, Scopus, and Web of Science. The scientific evidence was synthesized using qualitative analysis. All aspects of the study method followed COREQ guidelines. Results: Following a detailed systematic search and screening of 1405 studies, 10 were included in the systematic review. The study shows that implementing Welfare Technology seems to prolong older adults' independent living in their own homes and was perceived as a complement to face-to-face contact with health care providers. Conclusions: This study indicated that older adults consider accepting Welfare Technology as it contributes to a sense of security and empowerment in their everyday lives.

Welfare technology interventions among older people living at home-A systematic review of RCT studies.

The main goal of health services is for the elderly to maintain their mental and physical health and live at home independently for as long as possible. Various technical welfare solutions have been introduced and tested to support an independent life. The aim of this systematic review was to examine different types of interventions and assess the effectiveness of welfare technology (WT) interventions for older people living at home. This study was prospectively registered in PROSPERO (CRD42020190316) and followed the PRISMA statement. Primary randomized control trial (RCT) studies published between 2015 and 2020 were identified through the following databases: Academic, AMED, Cochrane Reviews, EBSCOhost, EMBASE, Google Scholar, Ovid MEDLINE via PubMed, Scopus, and Web of Science. Twelve out of 687 papers met the criteria for eligibility. We used risk-of-bias assessment (RoB 2) for the included studies. Based on the RoB 2 outcomes that showed a high risk of bias (>50%) and high heterogeneity of quantitative data, we decided to narratively summarize the study characteristics, outcome measures, and implications for practice. The included studies were conducted in six countries, namely the USA, Sweden, Korea, Italy, Singapore, and the UK. One was conducted in three European countries (the Netherlands, Sweden, and Switzerland). A total of 8437 participants were sampled, and individual study sample sizes ranged from 12 to 6742. Most of the studies were two-armed RCTs, except for two that were three-armed. The duration of the welfare technology tested in the studies ranged from four weeks to six months. The employed technologies were commercial solutions, including telephones, smartphones, computers, telemonitors, and robots. The type of interventions were balance training, physical exercise and function, cognitive training, monitoring of symptoms, activation of emergency medical systems, self-care, reduction of death risk, and medical alert protection systems. The latter studies were the first of their kind and suggested that physician-led telemonitoring could reduce length of hospital stay. In summary, welfare technology seems to offer solutions to supporting elderly people at home. The results showed a wide range of uses for technologies for improving mental and physical health. All studies showed encouraging results for improving the participants' health status.

Registered nurses' experiences and perceptions of supervising international nursing students in a clinical setting - A qualitative study.

AIM: The aim of the study was to examine the experiences and perceptions of Indian RNs who supervise Norwegian undergraduate nursing students during their clinical practice in India. BACKGROUND: The globalization process has generated a need for registered nurses (RNs) to develop cultural competence. As a result, nursing education and policy need to respond to the challenging nature of global health and prepare RNs to work with diverse cultures by enhancing their cultural competence to help them encounter patients from different cultural backgrounds. Yet, the research investigating the experience of supervisors in non-western countries receiving students from western countries is sparse DESIGN: An exploratory descriptive design. METHODS: Eight individual semi-structured interviews were undertaken by Indian Registered nurses, supervising Norwegian nursing students. Three of the interviews were conducted in their workplace in India, while the rest were carried out using Zoom conference due to the COVID19 pandemic. The interviews were conducted between January - December 2020. Inductive qualitative content analysis was used to analyse the data. RESULTS: Thematic analysis elicited four main themes: 1) Preparation to receive international students, 2) The role of supervising international students, 3) Learning from the students, 4) Challenges of supervising international students CONCLUSIONS: Participants provided valuable insights into the role of supervising international nursing students in India. This insight is considered important since many students from Western countries go to non-Western countries for international exchanges. The study highlights the fact that the method of supervision is connected to the culture and is different in Western and non-Western countries. Even though they acknowledged several challenges with having international students, supervisors emphasized that having international students was a positive experience and that they learned from them.

Measurement instruments for parental stress in the postpartum period: A scoping review.

BACKGROUND: Parenting stress is a particular type of stress that is conceptualized as a negative psychological response to the numerous obligations associated with raising children. Despite a considerable increase in research on parenting stress, little attention has been given to the ways parenting stress are measured. OBJECTIVES: This scoping review aimed to provide an overview of available instruments measuring parental stress and to describe their psychometric properties. METHODS: We conducted a scoping review in accordance with international guidelines for scoping reviews. The main search strategy was searches in seven electronic databases. Pairs of reviewers selected relevant studies based on predetermined inclusion and exclusion criteria. Studies had to report one or more psychometric properties of an instrument measuring stress in parents with children 0-12 months. For each included study, we collected information relevant to the review question, guided by the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN). Finally, we collated, summarized, and reported the findings descriptively. RESULTS: From 2164 unique record, 64 studies from 24 countries were included. They described 15 instruments, of which four were generic and eleven parental-specific self-administered instruments. Only two studies examined parental stress among fathers. Eleven of the studies were validation studies, but they only described seven of the 15 instruments. Internal consistency was the only information provided by 73.4% of the included studies. None of the instruments had information on all measurement properties as per the COSMIN criteria, and there was no information about measurement error, responsiveness, or interpretability for any of the 15 instruments. DISCUSSION: There are presently 15 instruments with some associated psychometric information being used to measure parental stress among parents with young children, but the amount of information on the instruments' psychometric properties is slight. There is a need for further research.

Effects of the Sonas Program on Anxiety and Depression in Nursing Home Residents with Dementia: A 6-Month Randomized Controlled Trial.

INTRODUCTION: There is a dearth of evidence about the effects of Sonas, a multisensory stimulation on people with dementia (PWD). The main aim of this study was to examine the effects of the Sonas program on anxiety and depression in nursing home (NH) residents with dementia. METHODS: In all, 120 PWD ≥65 years of age from 6 NHs were included in a randomized control trial and were allocated to 1 of 3 groups for 24 weeks: a Sonas program group (n = 48), a reading group (n = 32), and a control group (n = 40). One hundred and five participants completed follow-up assessments. Anxiety and depression were assessed by the Rating Anxiety in Dementia (RAID) scale and the Cornell Scale for Depression in Dementia (CSDD), respectively. Generalized linear mixed models were estimated to assess trends in the proportion of participants with anxiety (a RAID score ≥11) and depression (a CSDD score ≥10). RESULTS: No significant reduction in anxiety from baseline to follow-up was observed in any of the groups. Participants in the Sonas group showed a significant reduction in depression from baseline to 12 weeks (p = 0.001) and from baseline to 24 weeks (p = 0.009). CONCLUSION: The Sonas program had no effect on severity of anxiety but a reduction in depressive symptoms was found in PWD.

Ethical aspects in dementia care - The use of psychosocial interventions.

The use of psychosocial interventions for people with dementia is common and recommended because they focus on the underlying problem and well-being of the person. The promotion of well-being is a relevant dimension in person-centred care, where the aim is to confirm the person's 'personhood'. Most literature about ethics in dementia care instructs us on how and when to include people with dementia in our research. Little is written about the ethical aspects regarding the use of psychosocial interventions in daily care. In clinical practise, several challenges arise about the use of psychosocial interventions. Those include questions about the person's ability to participate in decision-making and how we know what is best for them. Furthermore, we must consider what kinds of psychosocial interventions are best for everybody, or if intervention causes discomfort for the person. This article emphasizes the necessity to consider the ethical aspects of the implementation of psychosocial interventions while taking into consideration the persons individual needs. A particular ethical challenge arises when a person with dementia is unable to express themselves verbally. Therefore, it is essential that the staff know the history and preferences of each person with dementia. The ethical aspects of psychosocial interventions for people with dementia will be discussed using Beauchamp and Childress four ethical principles: respect for autonomy, beneficence, non-maleficence and justice. The person-centred approach proposed by Kitwood's and Brooker.

Nursing Staff's Knowledge and Attitudes towards Dementia in an Indian Nursing Home: A Qualitative Interview Study.

BACKGROUND: Despite the increased prevalence of dementia in India, there is reported to be little awareness of the disease. This could lead to a late diagnosis, a reduced number of choices regarding future care, and misinterpretation of the symptoms or neglect. Taking into consideration that most nurses caring for older people in the future will work with people with dementia, there is concern that they may not be able to meet the needs of this group of patients unless they have the necessary knowledge and a positive attitude. AIM: To explore the knowledge about and attitude towards dementia among nursing staff working in residential care facilities for older people in India. METHOD: An explorative and descriptive qualitative design was used. Two semi-structured focus group interviews were conducted with nursing staff working in 6 nursing homes in India. Qualitative content analysis was used. Ethical approval was granted by the Norwegian Social Science Data Services. FINDINGS: The participants highlighted the following 3 dimensions in relation to their knowledge of and attitudes toward dementia in residential care facilities in India: (1) people with dementia - a walking mystery; (2) we need to go along with them, but it is challenging; and (3) if we know, we can care for them in a better way. CONCLUSION: The findings revealed a wide range of differences in attitude towards and inadequate knowledge of dementia among nursing staff. However, their overall attitudes toward people with dementia was positive.

Engagement in Everyday Activities among People Living in Indian Nursing Homes: The Association with Person-Centredness.

INTRODUCTION: It has been reported that residents living in nursing homes are often inactive and lonely and are offered a limited number of activities. However, high engagement in activities has been reported to improve residents' quality of life and engagement in personalized activities can even reduce agitation and enhance positive mood. Information regarding occupational patterns and purpose in life is well established in Western countries. However, we know next to nothing about how people living in Indian nursing homes spend their days. OBJECTIVE: To explore the participation in everyday activities among older people in Indian nursing homes and the extent to which engagement in activities is associated with person-centred care. METHODS: The study was conducted in 6 nursing homes in India, comprising 147 residents. In all, 23 nursing staff took part and completed a 26-item questionnaire about resident activities based on the Multi-Dimensional Dementia Assessment Scale and the Person-Directed Care Questionnaire. Person-centredness was measured with the Person-Centred Care Assessment Tool. RESULTS: We found low participation in everyday activities among the residents. Participation in religious activities was the most frequent, whereas the least used activities were excursions, participating in cultural activities, taking part in educational programmes, visiting a restaurant and going to the cinema. A significant positive association was found between person-centred care and participation in religious activities, engagement in an activity programme and physical activity. CONCLUSIONS: The most frequently attended activity was religious activities. Person-centred care was associated with participation in religious activities, engagement in an activity programme, physical activity, spending time in the garden and playing and listening to music.

Nursing Staff's Knowledge and Attitudes toward Dementia: A Pilot Study from an Indian Perspective.

BACKGROUND: Despite the increased prevalence of dementia in India, reports indicate little awareness of the disease. Symptoms are often misinterpreted or neglected, which could lead to late diagnosis, reducing the choices available regarding future care. Considering that most nurses caring for the elderly will work with people with dementia in the future, there is concern surrounding their ability to meet the needs of these patients, requiring them to obtain the necessary knowledge and positive attitudes for treatment. AIMS: To describe the knowledge of and attitudes toward dementia among nursing staff working in residential care facilities for elderly populations in India. METHODS: A cross-sectional survey was conducted in 3 nursing homes in India in which 15 nursing staff conducted self-assessments of their knowledge and attitudes toward dementia using the Alzheimer's Disease Knowledge Scale (ADKS) and the Attitude toward Alzheimer's Disease and Related Dementias Scale (DAS) for each respective assessment. Descriptive statistics were used to describe staffs' attitudes and knowledge concerning dementia. Continuous variables were presented as means ± SD, while the categorical variables were presented as percentages. RESULTS: Although the majority of the participants answered that Alzheimer's disease cannot be cured, about half reported that people with dementia, in rare cases, can recover from the disease. While all participants agreed that people with dementia can feel when others are kind to them, almost half disagreed that people living with dementia can enjoy life. CONCLUSION: These findings reveal that nursing staff have limited knowledge of dementia, but their attitudes toward people living with dementia tend to be positive.

Impact of the Sonas Programme on Communication over a Period of 24 Weeks in People with Moderate-to-Severe Dementia.

OBJECTIVES: The primary aim was to examine how communication abilities changed over time among nursing home residents with moderate-to-severe dementia who were attending the Sonas programme and to explore whether changes in communication abilities were related to cognitive ability. METHOD: A longitudinal secondary descriptive study method was employed, where 56 people with moderate-to-severe dementia attended a 45-min Sonas group session twice a week for 24 weeks. The Threadgold Communication Tool (TCT) was completed every 4 weeks. RESULTS: The impact of the Sonas programme on communication showed a significant non-linear trend in the TCT, with an increase in communication abilities during the first 16 weeks, regardless of the level of the residents' cognitive abilities. Thereafter it levelled out. No interaction was found between time and the frequency of attendances at Sonas sessions. Both verbal and non-verbal communication increased from the baseline, with non-verbal communication increasing quickly and verbal communication increasing marginally. CONCLUSION: Communication abilities increased with the time of the intervention, but the peak was achieved after 16 weeks, after which the effect levelled out. This suggest that the Sonas programme should be used for a period of at least 16 weeks before evaluating its effect.

Effect of the Sonas Programme on Communication in People with Dementia: A Randomized Controlled Trial.

BACKGROUND: Strategies to improve communication in people with dementia are warranted. We examined the effect of the Sonas programme on communication ability in persons with moderate to severe dementia. METHODS: A 24-week 3-armed (Sonas, reading, and control group) randomized controlled trial including 120 nursing home residents with dementia was conducted; 105 completed the follow-up assessments. The main outcome was change in communication abilities measured by the Holden Communication Scale (HCS). RESULTS: We found no overall significant effect of the Sonas programme with regard to communication ability as measured by the HCS. However, an effect between the Sonas group and the reading group and between the Sonas group and the control group from T0 to T1 and T2 was found, as well as a significant improvement in communication in the Sonas group. Among people with severe dementia, the Sonas group scored significantly better on the HCS compared to the reading group after 12 weeks, but not after 24 weeks. CONCLUSION: This study failed to document an overall effect of the Sonas programme on communication; however, the findings indicate that the Sonas programme has a significant effect on communication among those with severe dementia.

Psychometric evaluation of the Holden Communication Scale (HCS) for persons with dementia.

OBJECTIVE: To investigate the psychometric properties of the Holden Communication Scale (HCS) and the association between scores on HCS and cognitive function among persons with dementia. METHOD: Internal consistency was assessed by the Cronbach's α coefficient and inter-item correlations. Test-retest was carried out to test the instrument's stability. An exploratory factor analysis with the principal components extraction method and oblimin rotation was performed to evaluate construct validity. Pearson's correlation coefficients were calculated to explore associations between the scores on the HCS and cognitive function. RESULTS: A total of 128 persons with moderate-to-severe cognitive impairment (mean Mini-Mental State Examination (MMSE) score 8.9 (SD 7.0)) participated. The mean age was 85.2 (SD 7.2) and 101 of the participants were women. The Cronbach's α of the HCS was 0.94 and test-retest reliability was r=0.71. The corrected item-total correlation ranged from 0.63 to 0.79 and factor analysis showed a 1-factor structure of the HCS, which explained 63% of the variance. However, a forced 3-factor structure explained 76% of the variance. The correlation between cognitive function as measured by the MMSE and ability to communicate as measured with HCS was found to be moderate for those with an MMSE score of 0-10 (-0.61) and low for persons with an MMSE score of 11-20 (-0.06). CONCLUSIONS: The HCS is a reliable and valid scale for assessing communication ability in persons with moderate and severe cognitive impairment, and might have a 1-factor or 3-factor structure.

A Psychometric Evaluation of the Threadgold Communication Tool for Persons with Dementia.

BACKGROUND: The objective of this study was to investigate the psychometric properties of the Threadgold Communication Tool (TCT). METHOD: Internal consistency reliability was measured using Cronbach's α coefficient and inter-item correlation. Test-retest was performed to examine the instrument's stability. Exploratory principal component analysis (PCA) with oblimin rotation was carried out to evaluate construct validity. Finally, the score on each item of the TCT was correlated with the person's Mini Mental State Examination (MMSE) and Barthel Index of activities of daily living scores. RESULTS: A total of 51 persons participated, with a mean age of 86.7 (SD 6.6) years, of whom 46 were women with moderate-to-severe dementia [mean MMSE score 7.5 (SD 6.7)]. There were two measurement points 2 weeks apart. The results showed a satisfactory level for internal consistency and a high test-retest reliability (r = 0.76). The corrected item-total correlation ranged between 0.50 and 0.87, and a two-factor structure was revealed at the PCA. 'Vocalizing' seemed to measure another aspect of communication and was the only item which was negatively loaded. CONCLUSION: Despite the low sample size in this study, the results revealed the TCT as a reliable and valid instrument, suitable for measuring communication among people with dementia. We suggest clarifying the understanding of 'vocalizing' before considering removing it from the scale.