Jorunn Drageset

The impact of depression and sense of coherence on emotional and social loneliness among nursing home residents without cognitive impairment – a questionnaire survey

AIMS AND OBJECTIVES To analyse the relationships between depressive symptoms, sense of coherence and emotional and social loneliness among nursing home residents without cognitive impairment. BACKGROUND Depression symptoms and loneliness are major health problems for older people. Sense of coherence, which is based on a salutogenic theoretical framework, is a strong determinant of positive health and successful coping and is associated with well-being and depression among older people. Few studies have explored the relationships between depression symptoms, sense of coherence and emotional and social loneliness among nursing home residents. DESIGN A cross-sectional, descriptive, correlational design. METHODS Sample - 227 residents 65-102 years old from 30 nursing home residing ≥ six months. All had a Clinical Dementia Rating ≤ 0·5 and could converse. Residents were interviewed using the Social Provisions Scale, Geriatric Depression Scale and Sense of Coherence Scale (SOC-13). Possible relationships between these were analysed, controlled for sex, age, marital status, education, length of stay and comorbidity. RESULTS Before adjustment, Geriatric Depression Scale was associated with attachment and social integration. After adjustment, Geriatric Depression Scale was still associated with attachment and social integration. Further adjusting for Sense of Coherence Scale reduced the association between Geriatric Depression Scale and attachment and even more so for the association between Geriatric Depression Scale and social integration. Sense of coherence and Geriatric Depression Scale did not interact, and SOC-13 was associated with attachment and social integration. CONCLUSIONS Depression symptoms contribute to emotional and social loneliness. Independent of sense of coherence, depression symptoms are associated with emotional loneliness, sense of coherence influence emotional and social loneliness. RELEVANCE TO CLINICAL PRACTICE Clinical nurses should observe residents closely for signs of depression and loneliness and support their sense of coherence to reduce emotional and social loneliness.

Emotional loneliness is associated with mortality among mentally intact nursing home residents with and without cancer: a five‐year follow‐up study

AIMS AND OBJECTIVES Hypothesised that sociodemographic factors and illness variables would be associated with mortality and that emotional and social loneliness measured using the Social Provisions Scale would influence mortality among nursing homes residents with cancer. BACKGROUND Studies are lacking on how emotional and social loneliness influence mortality among cognitively intact older people in nursing homes with and without a diagnosis of cancer. DESIGN A cross-sectional design was used at baseline with a five-year follow-up of mortality. Methods.  A cohort of 227 cognitively intact (Clinical Dementia Rating scale score ≤0·5) older residents (60 with cancer and 167 without) from 30 nursing homes were followed from 2004-2005 to 2010. Data were collected by face-to-face interview. Sociodemographic variables and medical diagnoses were obtained from the records. RESULTS Survival did not differ significantly between residents with and without cancer. After adjustment for sociodemographic and illness variables, increasing age, higher education and comorbidity were associated with mortality. In the final model from a backward selection procedure, attachment (emotional loneliness) was associated with mortality. CONCLUSIONS Independent of a cancer diagnosis or not, emotional loneliness, age, education and comorbidity influenced mortality among nursing homes residents without cognitive impairment. RELEVANCE TO CLINICAL PRACTICE Nurses should pay attention to emotional loneliness among nursing homes residents independent of cancer and especially give attention to the importance to have a close confidant who provides emotional support.

Cancer-Related Pain and Symptoms Among Nursing Home Residents: A Systematic Review

CONTEXT Many older nursing home (NH) residents with cancer experience pain and distressing symptoms. Although some develop cancer during their time in the institution, an increasing number are admitted during their final stages of their lives. Numerous studies have evaluated various treatment approaches, but how pain and symptoms are assessed and managed in people with cancer with and without dementia is unclear. OBJECTIVES The objective of this review was to summarize the evidence on cancer-related symptoms among NH residents with and without dementia. METHODS We systematically searched the PubMed (1946-2012), Embase (1974-2012), CINAHL (1981-2012), AgeLine, and Cochrane Library (1998-2012) databases using the search terms neoplasms, cancer, tumor, and nursing home. The inclusion criteria were studies including NH residents with a diagnosis of cancer and outcome measures including pain and cancer-related symptoms. RESULTS We identified 11 studies (cross-sectional, longitudinal, clinical trial, and qualitative studies). Ten studies investigated the prevalence and treatment of cancer-related symptoms such as vomiting, nausea, urinary tract infections, and depression. Studies clearly report a high prevalence of pain and reduced prescribing and treatment, regardless of the cognitive status. Only one small study included people with cancer and a diagnosis of dementia. Studies of new cancer diagnoses in NHs could not be identified. CONCLUSION This review clearly reports a high prevalence of pain and reduced drug prescribing and treatment among NH residents with cancer. This issue appears to be most critical among people with severe dementia, emphasizing the need for better guidance and evidence on pain assessment for these individuals.

Cancer in nursing homes: characteristics and health-related quality of life among cognitively intact residents with and without cancer.

Background:Studies are lacking on how cancer influences physical, mental, and social functioning beyond comorbidity among older people without cognitive impairment in nursing homes (NHs). Objective:The objective was to study the sociodemographic characteristics and health-related quality of life (HRQOL) among NH residents with and without a cancer diagnosis, adjusting for comorbidity. Methods:This was a cross-sectional observation study: 30 NHs; 227 residents 65 to 102 years old: 60 with cancer and 167 without, at least 6 months’ residence. All had Clinical Dementia Rating of 0.5 or less and could converse. Health-related quality of life was measured using the 36-item Short-Form Health Survey in face-to-face interviews. Sociodemographic variables and medical diagnoses were obtained from records. Possible differences in HRQOL, controlled for age, gender, marital status, education, length of stay, and comorbidity, were examined by multiple linear regression analyses. Results:The most common cancer diagnoses were breast cancer among women (20%) and prostate cancer among men (12%). More residents with cancer were married (P = .007), reported more bodily pain (P = .17) and scored lower on all other HRQOL subscales, except for role-emotional. General health was worse than that of the residents without cancer (P = .04) after adjusting for sociodemographic variables but not for comorbidity (P = .06). Conclusion:Cognitively intact NH residents with cancer reported more pain and worse general health but better role limitation related to emotional problems compared with residents without cancer. The difference in general health was partly due to comorbidity. Implications for Practice:Nurses should pay attention to HRQOL among NH residents with cancer and especially observe and ensure pain treatment.

The Hospital Anxiety and Depression Scale—Dimensionality, reliability and construct validity among cognitively intact nursing home patients

BACKGROUND Depression and anxiety are particularly common among individuals living in long-term care facilities. Therefore, access to a valid and reliable measure of anxiety and depression among nursing home patients is highly warranted. AIM To investigate the dimensionality, reliability and construct validity of the Hospital Anxiety and Depression scale (HADS) in a cognitively intact nursing home population. METHODS Cross-sectional data were collected from two samples; 429 cognitively intact nursing home patients participated, representing 74 different Norwegian nursing homes. Confirmative factor analyses and correlations with selected constructs were used. RESULTS The two-factor model provided a good fit in Sample1, revealing a poorer fit in Sample2. Good-acceptable measurement reliability was demonstrated, and construct validity was supported. LIMITATIONS Using listwise deletion the sample sizes were 227 and 187, for Sample1 and Sample2, respectively. Greater sample sizes would have strengthen the statistical power in the tests. The researchers visited the participants to help fill in the questionnaires; this might have introduced some bias into the respondents׳ reporting. The 14 HADS items were part of greater questionnaires. Thus, frail, older NH patients might have tired during the interview causing a possible bias. CONCLUSION Low reliability for depression was disclosed, mainly resulting from three items appearing to be inappropriate indicators for depression in this population. Further research is needed exploring which items might perform as more reliably indicators for depression among nursing home patients.

Burden of care, social support, and sense of coherence in elderly caregivers living with individuals with symptoms of dementia.

Family members are often the care providers of individuals with dementia, and it is assumed that the need for this will increase. There has been little research into the association between the burden of care and the caregiver’s sense of coherence or receipt of social support. This study examined the relationship between the social support subdimensions and sense of coherence and the burden of care among older people giving care to a partner with dementia. The study was a cross-sectional observation study of 97 individuals, ≥65 years old and living with a partner who had symptoms of dementia. We used the Informant Questionnaire on Cognitive Decline in the Elderly, the Relative Stress Scale, the Social Provisions Scale, the Sense of Coherence Scale, and a questionnaire on sociodemographic variables. We used multiple regression analysis in a general linear model procedure. We defined statistical significance as p < 0.05. With adjustments for sociodemographic variables, the association with burden of care was statistically significant for the subdimension attachment (p < 0.01) and for sense of coherence (p < 0.001). The burden of care was associated with attachment and with sense of coherence. Community nurses and other health professionals should take necessary action to strengthen attachment and sense of coherence among the caregivers of people with dementia. Qualitative studies could provide deeper understanding of the variation informal caregivers experience when living together with their partner with dementia.

Anxiety and depression and mortality among cognitively intact nursing home residents with and without a cancer diagnosis: a 5-year follow-up study.

BACKGROUND Studies are lacking on how anxiety and depression symptoms influence mortality among cognitively intact older people in nursing homes (NHs) with a diagnosis of cancer versus those without cancer. OBJECTIVE We hypothesized that anxiety or depression was associated with survival and has greater effects on survival for residents with cancer than for those without cancer. METHODS A cohort of 227 cognitively intact (Clinical Dementia Rating scale score ≤0.5) older residents (60 with cancer and 167 without) from 30 NHs were followed from 2004-2005 to 2010. Data were collected using face-to-face interviews. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale subscales. Sociodemographic variables and medical diagnoses were obtained from the records. RESULTS The overall survival after 5 years was 17% for residents with cancer and 22% for residents without cancer. Depression and comorbidity were associated with significantly worse survival independent of a cancer diagnosis. Residents with cancer and symptoms of anxiety (subscores at least 8) had worse survival than those without anxiety symptoms (P = .02), but this was not found among the noncancer group. CONCLUSIONS Independent of a cancer diagnosis, depression symptoms and comorbidity were associated with mortality among cognitive intact NH residents. Having symptoms of anxiety predicted shorter survival among residents with a cancer diagnosis. IMPLICATIONS FOR PRACTICE Nurses should pay attention to depression symptoms among NH residents with and without a cancer diagnosis. Giving attention to residents with cancer and anxiety symptoms is especially important.

Loneliness, loss, and social support among cognitively intact older people with cancer, living in nursing homes--a mixed-methods study.

Background Loneliness is a significant psychosocial effect following a cancer diagnosis and may prevent people from engaging in social activities, thus creating difficulties in interpersonal relationships. This study investigated loneliness and social support among cognitively intact nursing home residents with cancer by using a quantitatively driven mixed-methods design with sequential supplementary qualitative components. Methods The quantitative component consisted of face-to-face interviews of 60 nursing home residents (≥65 years) using the one-item Loneliness Scale and the Social Provisions Scale. The supplementary psychosocial component consisted of qualitative research interviews about experiences related to loneliness with nine respondents. Results The quantitative results indicated that reassurance of worth was associated with loneliness. The experience of loneliness was identified by the following: loneliness that was dominated by a feeling of inner pain, feeling of loss, and feeling small. Loneliness was alleviated by the following: being engaged in activities, being in contact with other people, and occupying oneself. Conclusion Enhancing the lives of nursing home residents with cancer requires attending to the residents’ experience of loneliness and social relationships in a targeted and individualized manner. This might require screening all nursing home residents for early detection of loneliness. Revealing factors that may contribute to or reduce loneliness improves the ability to enhance people’s lives.

Sense of coherence among cognitively intact nursing home residents - a five-year longitudinal study

Aim and objectives: To examine how stable the sense of coherence (SOC) is over a five-year period among residents of nursing homes (NH) who are not cognitively impaired and whether components of social support influence SOC.Background: Many studies have investigated the stability of SOC, and the findings have been inconsistent. Social support is a crucial resource in developing SOC. Few researchers have studied the stability of SOC and how various social support dimensions influence changes in SOC among older NH residents who are cognitively intact.Design: The study was prospective and included baseline assessment and five-year follow-up.Methods: The sample comprised 52 cognitively intact NH residents (Clinical Dementia Rating score ≤0.5). We obtained data through direct interviews using the Social Provisions Scale and Sense of Coherence Scale.Results: SOC increased statistically significantly from baseline to follow-up. The social support subdimension reassurance of worth predicted change in SOC after adjustment for sociodemographic factors. When controlled for baseline SOC, attachment was associated with change in SOC, but reassurance of worth was not.Conclusions: The study indicates that the change in SOC over time during the 5 years of follow-up and the social support dimension attachment appear to be important components of change in SOC. Nursing personnel should be aware of the residents’ individual needs for attachment and the importance of emotional support for personal strength and ability to cope.

Validation of World Health Organization Assessment Schedule 2.0 in specialized somatic rehabilitation services in Norway

PurposeThe World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability covering six domains. The purpose of this study was to investigate the potential of the instrument for monitoring disability in specialized somatic rehabilitation by testing reliability, construct validity and responsiveness of WHODAS 2.0, Norwegian version, among patients with various health conditions.MethodsFor taxonomy, terminology and definitions, the Consensus-based Standards for the Selection of Health Measurement Instruments were followed. Reproducibility was investigated by the intra-class correlation coefficient (ICC) in a randomly selected sample. Internal consistency was assessed by Cronbach’s alpha. Construct validity was evaluated by correlations between WHODAS 2.0 and the Medical Outcomes Study 36-item Short Form, and fit of the hypothesized structure using confirmatory factor analysis (CFA). Responsiveness was evaluated in another randomly selected sample by testing a priori formulated hypotheses.ResultsNine hundred seventy patients were included in the study. Reproducibility and responsiveness were evaluated in 53 and 104 patients, respectively. The ICC for the WHODAS 2.0 domains ranged from 0.63 to 0.84 and was 0.87 for total score. Cronbach’s alpha for domains ranged from 0.75 to 0.94 and was 0.93 for total score. For construct validity, 6 of 12 expected correlations were confirmed and CFA did not achieve satisfactory fit indices. For responsiveness, 3 of 8 hypotheses were confirmed.ConclusionThe Norwegian version of WHODAS 2.0 showed moderate to satisfactory reliability and moderate validity in rehabilitation patients. However, the present study indicated possible limitations in terms of responsiveness.