Strategies to support older adults’ mental health during the transition into residential aged care: a qualitative study of multiple stakeholder perspectives

Abstract

Background The move from home into residential care is one of the most stressful life experiences for older adults. ‘Relocation stress’ is a significant risk factor for anxiety and/or depression in aged care residents. Whether long-term or recently diagnosed, these mood disorders are associated with a decline in overall well-being, daily functioning and independence. The mental health needs of older adults are often poorly recognised and supported, including during the transition into residential care. Despite growing interest in how to facilitate this major life transition, few studies have taken the perspective of multiple stakeholders. The aim of this study was to explore resident, relative and staff experiences of the transition into residential aged care, and to identify strategies to support the mental health of older adults at this time. The role of pastoral care practitioners to facilitate transitions and support residents’ mental health was also examined. Methods This phenomenological study involved individual interviews with 35 aged care residents, relatives and staff, between January and April 2021. Participants were selected using purposive sampling. Audio-recorded interviews were transcribed verbatim and supported by field notes. Data analysis followed Giorgi’s steps for qualitative data analysis. Results Results were distilled into three main categories related to the overall transition experience, recognising and responding to residents’ mental health needs, and tailoring support to individual needs. A novel contribution of this study relates to the need to address a broad misunderstanding of the role of pastoral care and subsequent under-utilisation of a potentially valuable resource. Conclusions By describing transition experiences and the resources to support residents’ mental health, findings of this study provide practical, ‘real world’ suggestions for reducing relocation stress. New resources developed from the findings include guides, checklists and short question-and-answer films, in which current residents and staff describe strategies to support mental health and overall quality of life. Similar resources could be used to support transitions in other care settings.

Depression within the First Year of Relocation to Residential Care/Assisted Living: Where You Come From Matters

“…To our knowledge, the relationship between previous location and depression had not previously been tested in the RC/AL literature. Although, previous studies note the high rates of emotional distress experienced during the first year relocation to RC/AL, regardless of previous setting (Davison et al, 2019;Polacsek & Woolford, 2022). Residents relocating directly from an acute/post-acute facility may experience a particularly stressful pathway to RC/AL.…”

“…Therefore, even if psychiatric notes are inaccessible, a pertinent psychosocial summary could still be obtained by the RC/AL. Residential long-term care staff report that psychosocial histories are helpful to promote mental health care and person-centered practices during relocation (Polacsek & Woolford, 2022). A barrier to this approach is that it remains unclear which system of care (i.e., hospitals, RC/ALs, or primary care) is best suited to obtain and prepare psychosocial summaries.…”

“…As mentioned, incidence and prevalence of depression are heightened within the first year of relocation (Davison et al, 2019; Hoover et al, 2010; Payne et al, 2002; Samus et al, 2013). One possible explanation for these findings is that relocation stress may exacerbate emotional symptoms, contributing to higher rates of depression during the transition and adjustment to RC/AL (Koa et al, 2004; Polacsek & Woolford, 2022). While some residents’ depressive symptoms will improve with psychosocial adjustment to the community, more than 40% of RC/AL residents’ depression symptoms persists beyond the first year of relocation (Koa et al, 2004; Samus et al, 2013).…”

“…Central to the RC/AL model of care is a commitment to holistic wellness, including the promotion of resident mental health (CEAL, 2010). Transitions to RC/AL represent an important time for resident mental health, as previous studies suggest that the incidence and prevalence of mental health concerns, such as depression, are highest within the first year of relocation (Davison et al, 2019; Hoover et al, 2010; Payne et al, 2002; Polacsek & Woolford, 2022; Samus et al, 2013). The majority of residents relocate to RC/ALs from private homes, other RC/ALs, or directly from hospitals or rehabilitation facilities (Kane et al, 2007).…”

The experience of entering residential aged care: The views of residents, family members and staff—an Appreciative Inquiry

“…1 Those who do enter residential care are more likely now than in the past to be older, 2 living with dementia 3 and experiencing multiple co-morbidities. [4][5][6] Risk factors for admission include increased frailty, decreased mobility, recurrent falls, compromised nutrition and poor medication compliance, resulting in complex care needs. 6,7 In Australia, entry to residential aged care requires a comprehensive assessment by a federally funded Aged Care Assessment Team, most commonly triggered as a result of recurrent presentation to a health-care service as the level of frailty increases.…”