First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention / Primeros pasos en la desinstitucionalización de adultos mayores: protocolo para la implementación de una intervención compleja

Background: Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. Objective: To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. Methods: This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. Discussion: Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community.(AU)

Introducción: Las residencias de personas mayores cobran cada vez más importancia como centros de atención al final de la vida. Sin embargo, muchos adultos mayores desean permanecer en sus casas mientras envejecen. Objetivo: Se pretende evaluar la viabilidad de un proceso de desinstitucionalización en adultos mayores seleccionados que viven en las residencias y que expresen la voluntad para iniciar el proceso. Métodos: Este estudio, dividido en dos fases, se llevará a cabo durante 15 meses en 241 sujetos que viven en dos residencias de personas mayores en Navarra (España). La primera fase tiene un diseño transversal en donde se identificarán los factores y covariables asociadas a la viabilidad y voluntad para participar en un proceso de desinstitucionalización a través de un análisis bivariante, los recursos imprescindibles para el proceso y los residentes que quieran participar en él. La segunda fase tiene un diseño de intervención compleja en la que se implementa un proceso de desinstitucionalización. Se realizará un análisis exploratorio descriptivo y comparativo para caracterizar a los participantes, los servicios prescritos y el efecto de la intervención de desinstitucionalización a lo largo del tiempo (la calidad de vida será la variable principal; las secundarias serán las referentes a la salud, las psicosociales y de uso de recursos). Este estudio irá acompañado de un subestudio pseudocualitativo y emergente para identificar las barreras y los elementos facilitadores relativos a la implementación de este proceso y comprender cómo los componentes de la intervención y el contexto influyen en los resultados del estudio principal. Los componentes de la intervención y su ejecución serán de gran relevancia en el análisis. Discusión: Las alternativas a la institucionalización con viviendas adaptadas y apoyos comunitarios pueden permitir a las personas que así lo desean el retorno a la comunidad.(AU)

First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention.

BACKGROUND: Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. OBJECTIVE: To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. METHODS: This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. DISCUSSION: Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community. TRIAL REGISTRATION: NCT05605392.

Therapeutic Lying as a Non-Pharmacological and Person-Centered Approach in Dementia for Behavioral and Psychological Symptoms of Dementia.

The acceptance and ethics behind therapeutic lying (TL) as a non-pharmacological intervention for behavioral and psychological symptoms of dementia (BPSD) among persons with dementia continues to generate heated debates. This article presents a discussion of the ethical and cultural challenges on the perception of TL by people with dementia, their families, and health care professionals. Additionally, decision-making before TL was analyzed, including the types of TL, its efficacy and implications, alternatives to TL, and the ethical principles behind it. The results from this analysis show that TL is a common practice for BPSD. Its benefits include the reduction of these symptoms as well as the use of physical or chemical restraints. However, there is no consensus on its suitability as an approach, nor on the appropriate way it should be used. More experimental studies are needed to create legal and clinical intervention protocols that respect the fundamental rights of people with dementia promoting coherence, good ethical practices, and guidelines for person-centered care.

[Development of a subjective quality of life scale in nursing homes for older people (CVS-R).] / Desarrollo de una escala de calidad de vida subjetiva en residencias de personas mayores (CVS-R).

OBJECTIVE: The quality of life in nursing homes is a growing concern. Its assessment requires instruments that consider the subjective needs of residents, their families, and staff, such as the questionnaire (CVS-R) that has been developed and validated in the present study. METHODS: The original 100 items version was applied to 99 participants from three nursing homes (36,4% professionals, 30,30% residents and 33,33% family members). From the item analysis, a questionnaire with 27 questions and 9 dimensions was obtained, which, subsequently, 225 people from other nursing homes in Spain filled in online. Content validity was analyzed by expert judgment, and construct validity by factor analysis. Reliability was assessed by analyzing the internal consistency with Cronbach's alpha. RESULTS: The factorial analysis confirmed the existence of a single factor that explains 62.35% of the total variance of the questionnaire. Cronbach's alpha was 0.97. No relationship was found between sex and the final score of the questionnaire. CONCLUSIONS: The psychometric properties of the CVS-R support its use for the assessment of the subjective quality of life of nursing homes in Spain. The CVS-R considers, for the first time, the perception of residents, families and staff.

OBJETIVO: La calidad de vida en residencias de personas mayores es una preocupación creciente. Su evaluación requiere instrumentos que consideren las necesidades subjetivas de residentes, familias y profesionales, como el cuestionario (CVS-R) que se desarrolló y validó en el presente estudio. METODOS: La versión original de 100 ítems fue aplicada a 99 personas procedentes de tres residencias (36,4% profesionales, 30,30% residentes y 33,33% familiares). Del análisis de los ítems se obtuvo un cuestionario de 27 preguntas y 9 dimensiones que, posteriormente, rellenaron de forma online 225 personas de otras residencias de España (62% profesionales, 23% residentes y 14% familiares). Se analizó la validez de contenido mediante valoración por expertos y la validez de constructo mediante análisis factorial. Se evaluó la fiabilidad analizando la consistencia interna con el alfa de Cronbach. RESULTADOS: El análisis factorial confirmó la existencia de un solo factor que explica el 62,35% de la varianza total del cuestionario. El alfa de Cronbach fue de 0,97. No se encontró relación entre el sexo y la puntuación final del cuestionario. CONCLUSIONES: Las propiedades psicométricas del CVS-R apoyan su uso para la evaluación de la CV subjetiva de residencias de personas mayores de España. El CVS-R recoge, por primera vez, la percepción de residentes, familias y profesionales.

Diseño y validación de dos escalas sobre actitudes y conocimientos ante la terapia con muñecas en demencias / Design and validation of two scales about attitudes and knowledge regarding doll therapy in dementia

INTRODUCCIÓN: Las intervenciones no farmacológicas suelen ser objeto de debate en el ámbito científico. Por ello, resulta fundamental conocer qué actitudes tienen los profesionales de la salud hacia la novedosa terapia con muñecas en demencias (TCMD). El objetivo de este estudio fue diseñar y validar dos cuestionarios para conocer las actitudes y conocimientos ante la TCMD en profesionales de la salud. MATERIAL Y MÉTODOS: Participaron 120 profesionales de la Geriatría y Gerontología hispanohablantes con una media de edad de 38,3 años (DT = 10,99), en su mayoría mujeres (88,3%). Se diseñó y aplicó un cuestionario (TCM_DEMCO) de conocimientos sobre la TCMD y un cuestionario (TCM_DEMAC) de actitudes hacia la TCMD. La validez de constructo se valoró mediante análisis factorial exploratorio y se calculó la fiabilidad por medio del alfa de Cronbach. RESULTADOS: El análisis factorial exploratorio del cuestionario TCM_DEMCO retuvo 10 ítems en 5 factores («entorno y demencia», «aplicación terapéutica», «actividades», «metodología» y «beneficios e implicaciones») que explicaron el 70,1% de la variabilidad total, para el que se obtuvo un valor de coeficiente alfa de Cronbach > 0,50. El análisis factorial exploratorio del cuestionario TCM_DEMAC retuvo 10 ítems en dos factores («actitudes positivas» y «actitudes negativas») que explicaron un 61,2% de la variabilidad total, para el que se obtuvo un valor alfa de Cronbach > 0,85. CONCLUSIONES: Ambos cuestionarios suponen una herramienta breve para conocer las actitudes y conocimientos de los profesionales de la Geriatría y Gerontología hispanohablantes en materia de TCMD. Los análisis de fiabilidad y validez realizados han mostrado buenas propiedades psicométricas de estos instrumentos

INTRODUCTION: Non-pharmacological interventions are often the subject of debate in the scientific field. Therefore, it is essential to know the attitudes that health professionals have towards the novel Doll Therapy in Dementia (DTD). The objective of this study was to design and validate two questionnaires to find out the attitudes and knowledge on DTD in health professionals. MATERIAL AND METHODS: A total of 120 Spanish-speaking Geriatrics and Gerontology professionals, with a mean age of 38.3 years (DT = 10.99), participated, mostly women (88.3%). A questionnaire (TCM_DEMCO) on knowledge about the DTD and a questionnaire (TCM_DEMAC) on attitudes towards the DTD were designed and applied. The construct validity was assessed by exploratory factor analysis, and reliability was calculated using Cronbach's alpha. RESULTS: The exploratory factor analysis of the TCM_DEMCO questionnaire retained 10 items in 5 factors ("environment and dementia", "therapeutic application", "activities", "methodology" and "benefits and implications") that explained 70.1% of the total variability, giving a Cronbach alpha coefficient value > 0.50. The exploratory factor analysis of the TCM_DEMAC questionnaire retained 10 items in two factors ("positive attitudes" and "negative attitudes") that explained 61.2% of the total variability, giving a Cronbach alpha value > 0.85. CONCLUSIONS: Both questionnaires are a brief tool to learn about the attitudes and knowledge of Spanish-speaking Geriatrics and Gerontology professionals in matters of DTD. The reliability and validity analyses performed showed good psychometric properties of these tools

[Design and validation of two scales about attitudes and knowledge regarding doll therapy in dementia]. / Diseño y validación de dos escalas sobre actitudes y conocimientos ante la terapia con muñecas en demencias.

INTRODUCTION: Non-pharmacological interventions are often the subject of debate in the scientific field. Therefore, it is essential to know the attitudes that health professionals have towards the novel Doll Therapy in Dementia (DTD). The objective of this study was to design and validate two questionnaires to find out the attitudes and knowledge on DTD in health professionals. MATERIAL AND METHODS: A total of 120 Spanish-speaking Geriatrics and Gerontology professionals, with a mean age of 38.3 years (DT = 10.99), participated, mostly women (88.3%). A questionnaire (TCM_DEMCO) on knowledge about the DTD and a questionnaire (TCM_DEMAC) on attitudes towards the DTD were designed and applied. The construct validity was assessed by exploratory factor analysis, and reliability was calculated using Cronbach's α. RESULTS: The exploratory factor analysis of the TCM_DEMCO questionnaire retained 10 items in 5 factors ("environment and dementia", "therapeutic application", "activities", "methodology" and "benefits and implications") that explained 70.1% of the total variability, giving a Cronbach α coefficient value > 0.50. The exploratory factor analysis of the TCM_DEMAC questionnaire retained 10 items in two factors ("positive attitudes" and "negative attitudes") that explained 61.2% of the total variability, giving a Cronbach α value > 0.85. CONCLUSIONS: Both questionnaires are a brief tool to learn about the attitudes and knowledge of Spanish-speaking Geriatrics and Gerontology professionals in matters of DTD. The reliability and validity analyses performed showed good psychometric properties of these tools.