Enhancing Long Term Care and Caregiving

Keywords:

• Long Term Care
• Caregiving
• Aging
• Mental Health

Dear Fellow Clinical Gerontologists

Clinical Gerontologist strives to support and celebrate the work of early career scholars through constructive review of their work and through our annual student award. We begin this issue with an important review by a new and emerging professional and mentor. In a review of 45 studies focusing on the role of activity personalization in nursing home residents, Shryock and Meeks find strong support for individually tailored activities for enhancing well-being (Shryock & Meeks, 2020). A second innovative review focuses specifically on the application of the “knowledge to action” framework to behavioral medicine interventions for chronic diseases in six studies (Boscart et al., 2020). Clinical Gerontologist also seeks to elevate work which addresses diverse populations. Our final review in this issue addresses the needs of LGBTQ residents in long-term care, integrating the findings of 20 studies (Fasullo, McIntosh, Buchholz, Ruppar, & Ailey, 2021).

Mental health following transition to long term care is a critical concern, as evidenced by high rates of depression and anxiety at admission and over time in residents admitted to 42 nursing homes (Davison, McCabe, Busija, Martin, & Graham, 2021). Such findings, consistent with prior work, point to the ongoing need for behavioral health programs to facilitate adjustment and mental health. The Program to Enhance Adjustment to Residential Living (PEARL) is a five-session intervention designed to improve behavioral health in residents newly admitted to long-term care. In a cluster randomized trial of 219 newly admitted residents, PEARL helped adjustment, quality of life, and anxiety at six months (Davison, McCabe, Busija, & Graham, 2022); previous work demonstrated PEARL’s impact on depressive symptoms (Davison et al., 2021). Not only are nursing home transitions hard for residents, but they can also be hard for family members. The Residential Care Transition Module (RCTM) targets spouses after their family member moves to a nursing home. Results of a pilot randomized trial found promising effects of RCTM for reducing stress, depression and the experience of “hassles” in spouses (Brooks, Beattie, Edwards, Fielding, & Gaugler, 2021). Prior to relocation, it may be helpful to maximize decisional control to mediating post-relocation adjustment (Regier & Parmelee, 2021). Balancing concerns for independence with those about physical, emotional, and social health is complicated, particularly when considering the perspectives of older adults, family members, and clinicians (Davila & Johnson, 2021). These issues are even more complex for rural older adults and family members who describe barriers to aging in place including limited caregiver support and advance care planning (Quinlan et al., 2020).

The need for innovative and justly applied behavioral health interventions is underscored in an important investigation of antipsychotic use in Virginia nursing homes, which found that facilities in the top quintile of antipsychotic had high rates of use which was associated with social determinants of health that are not addressed by existing antipsychotic reduction measures (Winter, Kerns, Winter, Richards, & Sabo, 2022). Barriers to providing behavioral health in long-term care include reimbursement and facility structures, clinician time and training, and resident interest, stigma, and cognitive impairment (Plys, Beam, Boxer, & Portz, 2021). Successful implementation of behavioral health services in long-term care requires creativity and flexibility as described in several papers in this issue which document barriers and facilitators for group mental health intervention (Strong, Plys, Hartmann, Hinrichs, & McCullough, 2020), activity engagement (Plys & Qualls, 2019), and consumer directed care (Mellor et al., 2022).

Being a professional caregiver in long-term care can be both rewarding and challenging. Emotional regulation strategies are critical to countering burnout (Bamonti, Smith, & Smith, 2020), as is empathy, although such empathy may be associated with higher levels of depressive symptoms (Maximiano-Barreto et al., 2021). Programs to enhance empathy in professional caregivers, can balance both the challenges of increasing empathy while reducing stress and burnout (Han & Kim, 2020).

A final set of papers in this issue turns our attention to the family caregivers who describe both positive and negative aspects of caregiving (Shrestha et al., 2020), which can vary based on proximity as described in a study of long-distance caregivers (Falzarano, Cimarolli, Minahan, & Horowitz, 2020) and may be influenced by cultural and ethnic factors as described in a study of Vietnamese families (Miyawaki, Meyer, Chen, & Markides, 2020). Self-compassion and dispositional mindfulness may serve as important buffers against distress for family caregivers (Murfield, Moyle, O’Donovan, & Ware, 2020), as does understanding the role and complexity of experiences of guilt (Gallego-Alberto et al., 2020). There is a large body of literature demonstrating the effectiveness of behavioral health interventions for caregivers of persons living with dementia. Newer work focuses on novel approaches – such as a guilt-focused intervention (Romero-Moreno et al., 2022) and a benefit finding intervention for caregivers of older adults who are post-stroke (Fu et al., 2020). In such interventions, it is helpful to know that both on-site and virtual caregiver interventions can be equally effective (Karagiozi et al., 2021). While supporting emotional health for older adults in need of extra care at home or in long-term care can be challenging, it is heartening to see so much good work being done to develop and extend effective interventions for older adults and those who provide and support their care.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This material is the result of work supported with resources and the use of facilities at the VA Boston Healthcare System. The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.