Engaging in Everyday Activities Can Help Nursing Home Residents Thrive
by Lynn Hetzler
Residents should thrive in a nursing home, not merely survive with chronic illness. A new study shows that, in order to thrive, nursing home residents need to engage in more everyday activities.
There are about 1.4 million people residing in certified nursing facilities, according to the Centers for Disease Control and Prevention (CDC). Failure to thrive affects 25 to 40 percent of nursing home residents.
Nursing home residents who thrive have a higher level of functioning in activities of daily living, are less physically and cognitively impaired, and enjoy a higher quality of life.
Quality of Life in Nursing Homes
Previous research into quality of life among nursing home residents focused primarily on the prevention and management of neuropsychiatric symptoms, particularly in those with dementia and other cognitive problems, and the use of psychotropic drugs to manage these symptoms. Highly prevalent and potentially leading to poor medical and functional outcomes, neuropsychiatric symptoms can include depression, apathy, dysphoria, anxiety, irritability, agitation, aberrant motor behavior, and even Parkinsonian-like signs.
The mere absence of neuropsychiatric symptoms does not necessarily mean that the resident is thriving, however. By definition, to thrive is to prosper and flourish. In a healthcare setting, such as an extended care facility, thriving is the individual resident’s sense of well-being in relation to the nursing home environment. Thriving can promote health and positive experiences in residents in a way that optimizes other therapies.
While its prevalence increases with age, failure to thrive is not a normal part of aging. Several risk factors, such as multiple comorbidities, dementia, limited or decreased mobility, and reduced ability to deal with physical stresses can increase the risk for failure to thrive in older adults.
Failure to thrive can have devastating consequences for nursing home residents. The Institute of Medicine defines failure to thrive in the elderly as a more than five percent weight loss, decreased appetite, poor nutrition and physical inactivity. Dehydration, depression, immune dysfunction, and low cholesterol are also associated with failure to thrive.
Weight loss and the physical, psychological and social consequences that accompany it can lead to poor quality of life and mortality. Loss of height and strength, lower metabolic rate, and changes in the gastrointestinal tract contribute to further loss of appetite, social isolation and depression.
Failure to thrive in the elderly may result in cancer metastases, chronic lung disease and respiratory failure, renal insufficiency and renal failure. Elderly residents with failure to thrive may develop diabetes, osteoporosis, or vision loss. Depression and other psychiatric disorders are common among these older adults, as are hip fractures, inflammatory bowel disease, rheumatologic diseases, stroke, and cardiac problems.
Healthcare professionals sometimes describe failure to thrive in the elderly as “The Dwindles,” represented by the “11 Ds,” which are:
- Diseases (medical illness)
- Drinking alcohol, or engaging in other substance abuse
- Dysphagia that interferes with the ability to swallow
- Deafness, blindness, other sensory deficits
- Desertion by family and/or friends, resulting in social isolation
The new study shows that nursing home residents need more activities to help them avoid The Dwindles and thrive in an extended care environment.
Effects of Resident Thriving in Nursing Homes
A May 2016 study published in the Journal of Advanced Nursing (JAN) described how thriving can affect resident outcomes. Scientists in that sampled data from 191 residents of a large Swedish nursing home and separated the participants into two groups: those who scored highly on a thriving test and those who had low scores.
The researchers found that the residents who thrived had a shorter stay at the facility, were more capable of performing activities of daily living, had less cognitive impairment, fewer behavioral and psychological problems, and a higher quality of life. Those who were thriving were also better able to walk and could spend more time outdoors as compared with those residents who were not thriving.
New Study Establishes Association Between Thriving and Engagement in Everyday Activities
In the national, cross-sectional survey of 172 Swedish nursing homes, facility staff members completed questionnaires regarding the commonly occurring everyday activities of the 4831 residents they served. The residents participating in the study ranged in age from 47 to 107 years and were 86 years old on average. About two-thirds of the residents were female.
The researchers then performed simple and multiple linear regression, descriptive statistics, and linear stepwise multiple regression.
The researchers also published their findings in the world-leading, international peer-reviewed journal JAN. The results showed that most of the residents had been outside the nursing home within the previous week, but that only 20 percent of residents had been on some type of outing or excursion.
The most common activities included receiving physical touch, such as hugs, receiving visitors and talking to friends and relatives, and chatting with staff about topics unrelated to care and grooming. The least commonly occurring activities include going to a theater to watch a movie, attending educational programs, eating at a restaurant, and performing everyday chores.
The researchers found positive associations between thriving and activity engagement. Specifically, they found that engagement in an activity program, dressing nicely, and spending time with a favorite person had the strongest positive association with thriving. Of those three activities, engaging in an activity program had the greatest influence on thriving.
The results of the study suggest that engaging in everyday activities is important to resident thriving. Increasing engagement in such activities as a nursing intervention can help resident thrive in nursing homes.
“The study demonstrates that activities are an important approach to increasing thriving, and that everyday activities can be conceptualised and implemented as nursing interventions to facilitate resident thriving as opposed to resident surviving in nursing home care,” said lead author of the Journal of Advanced Nursing study, Sabine Björk, in a press release.
“If I was the daughter or spouse of a nursing home resident, I would be more interested in to what extent the care was person-centered and how staff work together with residents to facilitate social engagement and activities despite their physical and/or cognitive impairments,” Bjork added, “rather than the prevalence rate of physical activities in the nursing home.”