Objective To comprehensively review studies on dog‐assisted interventions (DAIs) among older people in residential long‐term care facilities (RLTCFs) and to provide an overview of their interventions, outcomes and methodological quality. Method We searched 18 electronic databases to identify English articles (published January 2000–December 2019) reporting on well‐defined DAIs targeting older adults (≥65 years) in RLTCF. Data were extracted by two independent reviewers. Descriptive statistics were produced for quantitative studies, with key themes identified among qualitative studies. Where possible, estimates were pooled from randomised controlled trials using random effects meta‐analyses. Results Forty‐three relevant studies (39 quantitative; 4 qualitative) were identified. The majority of quantitative studies were assessed as low‐quality according to the MMAT criteria (n = 26, 67%). Almost half of the quantitative studies (n = 18, 46%) found no significant changes over time or between groups across outcomes measured. The most salient intervention effects included improved social functioning (n = 10), reduced depressive symptoms (n = 6) and loneliness (n = 5). A random‐effects meta‐analysis revealed a medium effect in favour of DAT on reducing depressive or loneliness symptoms (pooled SMD: 0.66, 95%CI 0.21–1.11; I2 = 50.5; five trials), relative to treatment as usual. However, compared to treatment as usual, no overall effect of DAI on activities of daily living was detected (p = .737). Key themes from qualitative studies included (a) animals as effective transitional objects, (b) the therapeutic value of pets and (c) the significance of the care environment and stakeholders in facilitating DAI. Implications for practice The findings of this review indicate that while DAI has value for older people in RLTCF, challenges remain in accurately measuring its impact to provide a stronger evidence‐base. Standardisation of DAI service design, delivery and evaluation is required for future research and practice in providing holistic care for older adults.
ObjectiveTo report on the conceptualisation of a model for residential aged care in Australia.MethodsThree‐stage approach involving initial model conceptualisation; extensive consultation with stakeholders to test and develop the model for feasibility and acceptability; and examination of whether the model addresses circumstances that arise in scenarios of organisational failure.ResultsA model consisting of five domains relevant to the experience of older adults living in residential aged care—health care; social inclusion; rights; personal care and re‐ablement; and dementia management.ConclusionsThis proposed model of residential aged care takes as its purpose the provision of person‐centred care to older people with complex health issues, requiring end‐of‐life care, and/or living with dementia. This includes supporting dignity of risk and quality of life and enabling older adults to thrive.
Dog-assisted interventions (DAI) have been shown to have a wide-range of potential benefits for older adults living in care homes. Yet, there is a lack of published qualitative research which explores the experiences of care home residents, staff and dog-owner volunteers involved in DAI to fully understand its meaning, impact and value. This study aimed to explore the impact of a DAI on the social and emotional wellbeing of older residents living in care homes. The research employed a qualitative study design comprising overt, naturalistic researcher observation of weekly DAI sessions with 54 older adult residents across four participating care homes in the South East region of England over 3 months in 2018. Data were also collected through focus groups with 12 care home staff and 7 dog-owner volunteers. The data from the observations and focus groups was individually coded followed by thematic analysis across the three data sources. Findings demonstrated there were clear benefits for older people who engaged with DAI, as well as for dog-owners and to some extent for care home staff members. Benefits included sensory, emotional stimulation and opportunities for social interaction, reminiscence on early life experiences and these were supported by the development of some new social relationships. While there were some environmental challenges to implementing DAI, the findings confirm its value for care home residents, with minimal drawbacks from an organizational standpoint. As a low cost intervention, adoption of DAI in care home settings appeared to strengthen relationships between residents and staff and enable wider relationships with an external community resource. K E Y W O R D S care homes, dog assisted intervention, older people, participant observation | 1451 JAIN et Al.and community-centred ways of working, support social and emotional wellbeing of older people living in care homes and promote inclusive use of community resources and external partnerships, are highly desirable (Charles & Carstensen, 2010;Waite, 2018).Studies of Animal-assisted intervention (AAI) in care settings have reported a wide range of benefits on wellbeing (Bernabei et al., 2013;Jain et al., 2020) such as improving psychosocial and physiological functioning (Allen et al., 2002), and reduction in levels of stress, depression and compassion fatigue among carers (Coleman, 2016). Yet, few studies on AAI to date have attempted to understand the experience and meaning of the animal-human interaction for older residents living in care homes (Pitheckoff et al., 2018), particularly for people with dementia (Peluso et al., 2018). Two-thirds of older residents in care homes have some form of dementia (Prince et al., 2014).
Resident-to-resident aggression (RRA) in nursing homes is a matter of serious and profound concern, yet action to eliminate or mitigate RRA is hampered by a paucity of research. The aim of this study was to explore key stakeholders' knowledge and perceptions of RRA in Australian nursing homes. A qualitative cross-sectional study design was used, and semistructured telephone interviews were conducted. Participants were purposively and conveniently sampled with replacement from a range of aged care, healthcare and legal professional bodies, as well as advocacy organisations. The interview contained 12 closed-ended questions and six open-ended questions about participants' knowledge, experiences, perceptions and attitudes to RRA. Participant characteristics and responses to closed-ended questions were aggregated and proportions calculated, and thematic analysis was conducted by two independent researchers using a directed content approach. Fifteen participants (11 females; 73.3%) in senior management positions were interviewed. All were familiar with the concept of RRA and just over half (n = 8; 53.3%) had witnessed an incident. Major themes included the nature and causes of RRA and attitudes and responses to RRA. Potential causes of RRA included maladaptation to nursing home life, transfer of pre-existing issues into the nursing home environment, physical environment and staffing-related issues. RRA was commonly viewed by participants as dangerous and unpredictable or, conversely, as expected behaviour in a nursing home setting. A person-centred care approach was considered most effective for managing and responding to RRA. The research demonstrates that understanding perceptions of RRA among key stakeholders is critical to identifying the nature and scope of the problem and to developing and implementing appropriate prevention strategies. RRA is common in nursing homes, with potentially fatal consequences for residents involved, and has serious implications for nursing home staff, managers, providers, and regulators. Despite this, the prevalence, impact, and prevention of RRA remains under-recognised and under-researched in Australia. This is the first Australian study to produce qualitative findings on the knowledge and perceptions of RRA in nursing homes among key stakeholders. This paper reports on the knowledge and perceptions of individuals in senior management and policy roles in aged care and related fields in relation to four themes: nature; causes; attitudes; and responses to RRA. Our findings highlight the complex and multifactorial nature of RRA. A movement towards person-centred care that promotes understanding of individual care needs is favoured as an approach to reducing RRA. Increased reporting of both minor and major incidents of RRA will help to identify patterns and inform appropriate responses. However, a cultural shift is first required to recognise RRA as a manageable and preventable health care and adult safeguarding issue.
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