Exploring resident thriving in Swedish nursing homes : the Umeå Ageing and Health Research Programme (U-Age) Thesis I

Sammanfattning: BackgroundThe population living in nursing homes is generally characterized by high age and female sex, as well as by physical and cognitive impairments. Also, negative symptoms such as pain and neuropsychiatric symptoms are reportedly common. Care in Swedish nursing homes is regulated by law and national guidelines implying that care is to be tailored to resident preferences and needs in order to facilitate their well-being. However, there is no national data source on the characteristics of nursing home residents or on measures of their well-being. Thriving and not merely surviving in nursing homes has been described as a subjective experience of place-related well-being resulting from interaction between residents and the nursing home environment in terms of the quality of care and caregivers, as well as from the physical and psychosocial environment. However, there is a gap in knowledge of whether and, if so, to what extent resident characteristics and factors in the nursing home environment are associated with resident thriving in nursing homes.AimThe overall aim of this thesis is to explore resident thriving in Swedish nursing homes, and the extent to which resident characteristics, neuropsychiatric symptoms, activities, and environmental factors are associated with resident thriving.MethodsThis thesis is based on cross-sectional baseline data from a national inventory of health and care in Swedish nursing homes collected in 2013–2014. The resident sample covered 4831 residents in 548 units from 172 nursing homes in 35 Swedish municipalities. The data were explored using descriptive statistics, as well as simple and multiple linear regression analyses and multilevel linear regression analyses. Resident characteristics and symptom prevalence as well as their associations with thriving; and engagement in everyday activities and their associations with thriving were explored in a sample comprising 4831 nursing home residents from 172 nursing homes. Associations between resident thriving and resident living conditions, nursing home facility and unit characteristics, and the psychosocial climate of units were explored in a sample comprising 4205 residents from 147 nursing homes.ResultsEngagement in everyday activities was positively associated with resident thriving, the strongest associations being found for engagement in an activity programme, dressing nicely, and spending time with someone the resident likes. Environmental factors associated with thriving were a positive psychosocial climate at the unit, having access to newspapers, residing in a special care unit, and residing in a facility that was unlocked during the day. Cognitive functioning was strongly associated with resident thriving. Aggressive and depressive symptoms were found to be negatively associated with resident thriving regardless of levels of cognitive functioning.ConclusionsEngagement in everyday activities can support thriving and can be conceptualized and implemented as nursing interventions to facilitate thriving in nursing homes. Factors in the nursing home environment can support resident thriving; in particular, the psychosocial climate of units seems to have a great influence. Aggressive and depressive symptoms were associated with lower levels of thriving. Targeting these symptoms would therefore seem to be a priority in nursing homes. The population living in Swedish nursing homes has a high prevalence of neuropsychiatric symptoms and cognitive impairment. Residents with cognitive impairment also commonly resided in general units. As all data were cross-sectional, longitudinal studies would be valuable to further explore causality. As resident data were based on proxy ratings, future research exploring residents’ perspectives on thriving would be valuable. The present findings contribute to our understanding of nursing home residents’ complex care needs and identify factors that could have an impact on their well-being. These findings can provide benchmark estimates for further research, quality assessment activities, as well as further clinical development work.