Purpose Establishing acceptability of complex interventions to stakeholders is vital in early scientific development. The purpose of this paper is to ascertain the acceptability of a program of equine-assisted activities (EAAP) for people with dementia by elucidating programmatic practices needed to enhance their safety and quality of life (QoL) from the perspectives of service providers. Design/methodology/approach Semi-structured interviews with five providers were analyzed using a basic qualitative approach. Findings Providers perceived the EAAP as acceptable and revealed potential mechanisms of change supporting well-being, including aspects related to the physical and social environment and person with dementia. Linkages identified among the EAAP and its physical and social context support its complexity. Providers explicated program practices that promoted safety and QoL, such as implementing staff trainings and tailoring activities to each person’s preferences and needs. These practices aligned with best dementia care approaches, underscoring that the EAAP is a promising complex intervention that merits further scientific development. Originality/value This work is novel and adds to the literature by illuminating the role of a community-based, animal-assisted program for enhancing the QoL of older adults with dementia residing in institutional care facilities.

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Objective This study aimed to examine the impact of COVID-19 on hospice Interdisciplinary team (IDT) members’ self-reported stress and identify possible sources of moral distress. Methods A cross-sectional survey was conducted using Qualtrics to understand the impact of COVID-19 on quality improvement initiative implementation and hospice IDT members’ general and dementia-specific care provision. Directed qualitative content analysis was used to analyze hospice IDT members’ responses from five open-ended survey questions that were indicative of stress and possible moral distress. Results The final sample consisted of 101 unique respondents and 175 comments analyzed. Three categories related to sources of moral distress based on hospice IDT member survey responses were identified: (1) impact of telehealth, personal protective equipment (PPE), and visit restrictions on relationships; (2) lack of COVID-19-specific skills; and (3) organizational climate. Sources of moral distress were categorized in 40% of all responses analyzed. Significance of results This study is one of the first to document and confirm evidence of potential stress and moral distress amongst hospice IDT members during COVID-19. It is imperative given the possible negative impact on patient care and clinician well-being, that future research and interventions incorporate mechanisms to support clinicians’ emotional and ethical attunement and support organizations to actively engage in practices that address clinician moral distress resulting from restrictive environments, such as the one necessitated by COVID-19.

Background: Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI) are not effective for all veterans. Equine-assisted interventions are emerging as an additional treatment modality, but little is known regarding the safe and effective delivery of these interventions. This study aimed to describe the following features of the body of literature concerning equine-assisted interventions among veterans: 1) veterans who have participated in equine-assisted interventions; 2) specific characteristics of equine-assisted interventions in veterans; and 3) the specific characteristics of research on equine-assisted interventions in veterans. Methods: We conducted a systematic mapping review of peer-reviewed literature reporting on equine-assisted interventions among veterans between 1980 and 2017. Searches of nine databases yielded 3336 unique records, six of which met the inclusion criteria and were reviewed. Data relevant to the study aims were extracted and analyzed. Results: Equine-assisted interventions among veterans disproportionately targeted psychosocial outcomes and yielded promising results. The detailed methods of EAI varied in the reported studies, ranging from communicating with the horse to mounted exercises. There was also great diversity in outcome measurement. The state of theoretical development regarding the mechanisms by which equine-assisted interventions benefit the veteran population is currently underdeveloped. Studies provided insufficient detail with respect to the description of the intervention, reasons for attrition, and the dose-response relationship. Conclusions: Scientific development of equine-assisted interventions targeting psychosocial outcomes among veterans is warranted to establish their efficacy. Targeted outcomes should be expanded, including outcomes more closely aligned with the nature of polytraumatic injuries. Future research must also emphasize the theoretical development of equine-assisted interventions for veterans and thoroughly describe the participants, components of the intervention, factors contributing to attrition, and optimal dose-response relationships.

Background Hospice care was initially designed for seriously ill individuals with cancer. Thus, the model and clinicians were geared toward caring for this population. Despite the proportion of persons living with dementia (PLWD) receiving hospice care substantially increased over the past 10 years, and their longer lengths of stay, established hospice interventions for this population are scarce. No systematic review has previously evaluated those interventions that do exist. We synthesized hospice intervention studies for PLWD, their families, and hospice professionals by describing the types of interventions, participants, outcomes, and results; assessing study quality; and identifying promising intervention strategies. Methods A systematic review was conducted using a comprehensive search of five databases through March 2021 and follow‐up hand searches. Included studies were peer‐reviewed, available in English, and focused on hospice interventions for persons with dementia, and/or care partners, and clinicians. Using pre‐determined inclusion and exclusion criteria, data was extracted guided by the Cochrane Checklist, and quality was assessed using a 26‐item Consolidated Standards of Reporting Trials (CONSORT) Checklist. Results The search identified 3235 unique studies in total, of which 10 studies met inclusion criteria. The search revealed three types of interventions: clinical education and training, usual care plus care add‐on services, and “other” delivered to 707 participants (mostly clinicians). Five studies included underrepresented racial and ethnic groups. Outcomes measured knowledge and skills, psychosocial and health outcomes, feasibility, and acceptability, with significant improvements in six studies. Study quality was reflective of early‐stage research with clinical education and training strategies showing deliberate progression towards real‐world efficacy testing. Implications Hospice interventions for PLWD are sparse and in early‐phase research. More research is needed with rigorous designs, diverse samples, and outcomes considering the concordance of care.

BackgroundWe sought to describe neuropsychiatric symptoms (NPS) among people living with dementia (PLWD) from diverse racial and ethnic groups receiving home health services while accounting for dementia severity, individual symptom prevalence, and neighborhood disadvantage.MethodsA prospective study using cross‐sectional data from n = 192 PLWD receiving skilled home healthcare in New Jersey enrolled in the Dementia Symptom Management at Home Program trial. We prospectively measured symptom prevalence with the Neuropsychiatric Inventory Questionnaire and dementia severity using the Quick Dementia Rating System. A one‐way ANOVA determined NPS prevalence by dementia severity (mild, moderate, severe). Fisher's exact tests were used to assess the association of individual symptom prevalence with race and ethnicity and cross tabs to descriptively stratify individual symptom prevalence by dementia severity among groups. A Pearson correlation was performed to determine if a correlation existed among neighborhood disadvantages measured by the Area Deprivation Index (ADI) state decile scores and NPS prevalence and severity.ResultsParticipants identified as non‐Hispanic White (50%), non‐Hispanic Black (30%), or Hispanic (13%). NPS were prevalent in 97% of participants who experienced 5.4 ± 2.6 symptoms with increased severity (10.8 ± 6.6) and care partner distress (13.8 ± 10.8). NPS increased with dementia severity (p = 0.004) with the greatest difference seen between individuals with mild dementia (4.3 ± 2.3) versus severe dementia (5.9 ± 2.3; p = 0.002). Few differences were found in symptom prevalence by racial and ethnic sub‐groups. Nighttime behaviors were higher in non‐Hispanic Black (78%), compared with non‐Hispanic Whites (46%) with moderate dementia, p = 0.042. State ADI scores were not correlated with the number of NPS reported, or severity.ConclusionsNPS were prevalent and increased with dementia severity with commonalities among racial and ethnic groups with varying levels of neighborhood disadvantage. There is a need for effective methods for improving NPS identification, assessment, and management broadly for homebound PLWD.

Insufficient descriptions of what comprises animal-assisted interventions and why and how they are presumed to work pose significant challenges to their replication and further scientific development. The purpose of this study was to construct a comprehensive research-based logic model describing a promising program of equine-assisted activities for older adults with Alzheimer’s disease and related dementias. Logic models can advance scientific development of innovative programs by elucidating their critical elements. Employing the qualitative method of directed content analysis, we conducted secondary analyses of previously collected interviews of five providers and fieldnotes of each programmatic session. Employing quantitative direct observational methods, we conducted secondary analysis of eight previously collected hour-long videotapes of four older adults with dementia during the program. The resulting logic model from our secondary analysis of mixed methods data elucidated the program’s purpose, assumptions, programmatic activities, and outcomes, plus congruent linkages across these elements. These findings can guide replication of the program in multiple research and practice contexts and support its future scientific development. Next research steps include evaluating short- and long-term outcomes beyond participants’ direct experiences of the program, clarifying the program’s optimal dosages, and ensuring fidelity of its implementation. This logic model may also help to inform scientific development of other animal-assisted interventions.

Purpose This case study aims to explore the appropriateness of an adaptive riding program for persons living with dementia through examining family members’ (care partners) reported outcomes. Design/methodology/approach Using convenience sampling, persons living with dementia and their care partners were recruited in Northern Colorado; after meeting inclusion criteria, they were invited to participate in the adaptive riding program. The program occurred for weekly, hour-long sessions for eight weeks. Field notes were collected during each session, and semi-structured interviews were conducted with five care partners after the program and analyzed by using theoretical thematic analysis. Findings Care partners found the adaptive riding program appropriate. Reported outcomes comprised three themes: well-being, meaning through social connections and function in daily life and aligned with the positive emotions, engagement, relationships, meaning, accomplishment (PERMA) theory of well-being. Originality/value To the best of the authors’ knowledge, this is the first study to explore the appropriateness of an adaptive riding program for persons living with dementia and their care partners who broadened understandings of the emotional, social and physical benefits. Findings support the inclusion of care partners in adaptive riding and may inform health-care providers’ recommendations for such programs.