Interventions for Improving Mental Health and Quality of Life of Older Adults with Mental Illness in Long-term Care: A Systematic Review and Meta-analysis

Authors

  • Benjawan Ngamwongwiwat Faculty of Nursing, Prince of Songkla University, Thailand.
  • Vineekarn Kongsuwan Faculty of Nursing, Prince of Songkla University, Thailand.
  • Praneed Songwathana Faculty of Nursing, Prince of Songkla University, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2023.261505

Keywords:

nterventions, Long-term care, Mental health, Meta-analysis, health, Older adults, Quality of life, Systematic review

Abstract

         Various mental health interventions have been provided to older adults living in long-term care facilities, but the overall effectiveness of these interventions in improving mental health and quality of life remains inconclusive. This study is the first systematic review and meta-analysis to investigate and report interventions’ effects on improving mental health and quality of life among this population. A comprehensive search was conducted from January to February 2022 using PubMed, CINAHL, ProQuest, Web of Science, and Cochrane databases to identify eligible intervention studies published in English from December 2011 to December 2021. The inclusion criteria required studies to measure mental health and quality of life as outcomes in individuals aged 60 years and older with mental illness living in long-term care facilities. Studies that measured only mental health or quality of life were excluded. The PRISMA guidelines were used to guide the study’s method and report. Two reviewers independently evaluated the included studies’ methodological quality and extracted data. A third reviewer resolved discrepancies.

         Six randomized controlled trials and two quasi-experimental studies were included for systematic review, of which five studies qualified for meta-analysis involving 658 participants. Due to high heterogeneity, subgroup analysis with a fixed effects model was conducted. The interventions integrating active social interactions reduced depressive symptoms (low certainty of the evidence). Additionally, reminiscence-based interventions improved the quality of life of older adults with mental illness (low certainty of evidence). Although the effectiveness of interventions remains inconclusive due to high heterogeneity, a limited number of studies in the meta-analysis, and low-quality evidence, this review suggested that nursing care and activities promoting active social interactions and reminiscence should be implemented in living in long-term care facilities to enhance the quality of life and mental health of older adults with mental illness. However, the types and components of interventions should be adjusted based on available resources and contextual factors. Further research with larger sample sizes and higher methodological quality is warranted to strengthen the evidence base in this area.

References

World Health Organization. Aging and health [Internet]. 2022 Oct 1 [cited 2022 May 2]. Available from: https:// www.who.int/news-room/fact-sheets/detail/ageing-and-health

United Nations. World population aging 2019: highlight [Internet]. [cited 2020 May 2]. Available from: https:// www.un.org/en/development/desa/population/ publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf

Harper S. Living longer within aging societies. J Popul Ageing. 2019;12(2):133-6. doi:10.1007/s12062-019- 09248-4.

Flaherty JH, Liu ML, Ding L, Dong B, Ding Q, Li X, et al. China: the aging giant. J Am Geriatr Soc. 2007;55(8): 1295-300. doi:10.1111/j.1532-5415.2007.01273.x.

Chu LW, Chi I. Nursing homes in China. J Am Med Dir Assoc. 2008;9(4): 237-43. doi:10.1016/j.jamda.2008.01.008.

Abbasian M, Nakhodaeezah M, Namjoo S, Khalili Z, Jahangiry L, Fadayevatan R, et al. Reasons for nursing home placement of older women in Tabriz, Iran: a content analysis. Iran J of Ageing. 2019;13(4):406-17. doi:10. 32598/SIJA.13.4.406.

Karamivand V. The causes of elderly residents in a nursing home from the viewpoint of elders. Iris J Nur & Car. 2019;2(2):1-5. doi:10.33552/IJNC.2019.02.000533.

Health Canada. Long-term facilities-based care [Internet]. 2004 Oct 1 [cited 2022 Dec 13]. Available from: https:// www.canada.ca/en/health-canada/services/home-continuing-care/long-term-facilities-based-care.html

Ferreira AR, Dias CC, Fernandes L. Needs in nursing homes and their relation with cognitive and functional decline, behavioral and psychological symptoms. Front Aging Neurosci. 2016;8:72. doi:10.3389/fnagi.2016.00072.

Perlman C, Kirkham J, Velkers C, Leung RH, Whitehead M, Seitz D. Access to psychiatrist services for older adults in long-term care: a population-based study. J Am Med Dir Assoc. 2019;20(5)610-6.e2. doi:10.1016/j.jamda. 2019.01.121.

Li Y. Provision of mental health services in US nursing homes, 1995-2004. Psychiatr Serv. 2010;61(4):349-55. doi:10.1176/ps.2010.61.4.349.

Stargatt J, Bhar S, Davison T, Pachana NA, Mitchell L, Koder D, et al. The availability of psychological services for aged care residents in Australia: a survey of facility staff: psychological services in aged care. Aust Psychol. 2017; 52(6):406-13. doi:10.1111/ap.12244.

Jester DJ, Hyer K, Bowblis JR. Quality concerns in nursing homes that serve large proportions of residents with serious mental illness. Gerontologist. 2020;60(7):1312-21. doi:10.1093/geront/gnaa044.

van der Wolf E, van Hooren SAH, Waterink W, Lechner L. Well-being in elderly long-term care residents with chronic mental disorder: a systematic review. Aging Ment Health. 2019;23(3):287-96. doi:10.1080/13607863.201 7.1408773.

Grabowski DC, O’Malley AJ, Afendulis CC, Caudry DJ, Elliot A, Zimmerman S. Culture change and nursing home quality of care. Gerontologist. 2014;54(Suppl 1):S35-45. doi:10.1093/geront/gnt143.

Keyes CLM. The mental health continuum: from languishing to flourishing in life. J Health Soc Behav. 2002;43(2):207-22. doi:10.2307/3090197.

Schönfeld P, Brailovskaia J, Margraf J. Positive and negative mental health across the lifespan: a cross-cultural comparison. Int J Clin Health Psychol. 2017;17(3):197-206. doi:10. 1016/j.ijchp.2017.06.003.

Centers for Disease Control and Prevention. Measuring healthy days: population assessment of health-related quality of life [Internet]. [cited 2023 Apr 17). Available from: https://www. cdc.gov/hrqol/pdfs/mhd.pdf

Centers for Disease Control and Prevention. Healthy People 2020 [Internet]. [cited 2023 Apr 17]. Available from: https://www.cdc.gov/nchs/healthy_people/hp2020.htm

Secretary’s Advisory Committee Report on Approaches to Healthy People 2030. Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030: recommendations for the Healthy People 2030 leading health indicators [Internet]. [cited 2023 Apr 17]. Available from: https://health.gov/sites/ default/files/ 2021-09/Committee-LHI-Report-to- Secretary_1.pdf

Awad AG, Voruganti LNP, Heslegrave RJ. Measuring quality of life in patients with schizophrenia. Pharmacoeconomics. 1997;11(1):32–47. doi:10.2165/00019053-19971 1010-00005.

Corrigan PW, Buican B. The construct validity of subjective quality of life for the severely mentally ill. J Nerv Ment Dis. 1995;183(5):281-5. doi:10.1097/00005053- 199505000-00001.

Geerts K, Bongers I, Buitenweg D, van Nieuwenhuizen C. Quality of life of people with severe mental health problems: testing an interactive model. Int J Environ Res Public Health. 2020; 17(11):3866. doi:10.3390/ijerph17113 866.

Samus QM, Rosenblatt A, Steele C, Baker A, Harper M, Brandt J, et al. The association of neuropsychiatric symptoms and environment with quality of life in assisted living residents with dementia. Gerontologist. 2005; 45 Spec No 1(1): 19-26. doi:10. 1093/geront/45.suppl_1.19.

Gramaglia C, Gattoni E, Marangon D, Concina D, Grossini E, Rinaldi C, et al. Non-pharmacological approaches to depressed elderly with no or mild cognitive impairment in long-term care facilities. A systematic review of the literature. Front Public Health. 2021;9:685860. doi:10.3389/fpubh. 2021.685860.

Ambrosi C, Zaiontz C, Peragine G, Sarchi S, Bona F. Randomized controlled study on the effectiveness of animal-assisted therapy on depression, anxiety, and illness perception in institutionalized elderly. Psychogeriatrics. 2019;19(1): 55-64. doi:10.1111/psyg.12367.

Hsu YC, Wright CL. The effects of a socially supportive activities program (SSAP) on mood in long term care: a pilot study. Geriatr Nurs. 2019;40(6):572-8 doi: 10.1016/j. gerinurse.2019.05.009.

Reinhardt JP, Horowitz A, Cimarolli VR, Eimicke JP, Teresi JA. Addressing depression in a long-term care setting: a phase II pilot of problem-solving treatment. Clin Ther. 2014; 36(11): 1531-7. doi:10.1016/j.clinthera. 2014.10.005.

Hamzehzadeh M, Golzari M, Rafiemanesh H, Meshki V, Abdolalizadeh M, Hoseini L, et al. Investigating the effectiveness of reminiscence therapy on elderlies depression and optimism: an experiment study. Prensa Med Argent. 2018;104(6):1-5. doi:10.41720032/ 745X.1000318.

Bailey EM, Stevens AB, LaRocca MA, Scogin F. A randomized controlled trial of a therapeutic intervention for nursing home residents with dementia and depressive symptoms. J Appl Gerontol. 2017;36(7):895-908. doi:10.1177/0733464815627956.

Thomas JM, Sezgin D. Effectiveness of reminiscence therapy in reducing agitation and depression and improving quality of life and cognition in long-term care residents with dementia: a systematic review and meta-analysis. Geriatr Nurs. 2021; 42(6):1497-506. doi:10.1016/j.gerinurse.2021.10.014.

Cho HK. The effects of music therapy-singing group on quality of life and affect of persons with dementia: A randomized controlled trial. Front Med. 2018;5:279. doi:10.3389/fmed.2018.00279.

Chen SC, Moyle W, Jones C, Petsky H. A social robot intervention on depression, loneliness, and quality of life for Taiwanese older adults in long-term care. Int Psychogeriatr. 2020; 32(8):981-91. doi:10.1017/s1041610220000459.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol. 2021;134:103-12. doi:10. 1016/j.jclinepi.2021.02.003.

The Cochrane Collaboration. Data extraction forms [Internet]. 2022 [Internet]. [cited 2022 Nov 12]. Available from: https://dplp.cochrane.org/data-extraction-forms

Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. West Sussex: John Wiley and Sons; 2008.

Iwano S, Kambara K, Aoki S. Psychological interventions for well-being in healthy older adults: systematic review and meta-analysis. J Happiness Stud. 2022;23:2389- 403. doi:10.1007/s10902-022-00497-3.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions (2nd ed). New Jersey: Cochrane; 2019.

Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1(2): 97-111. doi:10.1002/jrsm.12.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1-12. doi:10.1016/0197-2456 (95)00134-4.

Berger VW, Alperson SY. A general framework for the evaluation of clinical trial quality. Rev Recent Clin Trials. 2009;4(2):79-88. doi:10.2174/1574887097881 86021.

Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analyses [Internet]. [cited 2023 Apr 28]. Available from: https:// www.ohri.ca/programs/clinical_epidemiology/oxford.asp

Kirmayr M, Quilodrán C, Valente B, Loezar C, Garegnani L, Franco JVA. The GRADE approach, Part 1: how to assess the certainty of the evidence. Medwave. 2021;21(2): e8109. doi: 10.5867/medwave.2021.02.8109.

Brooker DJ, Argyle E, Scally AJ, Clancy D. The enriched opportunities programme for people with dementia: a cluster-randomized controlled trial in 10 extra care housing schemes. Aging Ment Health. 2011;15(8):1008-17. doi:10.1080/13607863.2011.583628.

Chenoweth L, Forbes I, Fleming R, King MT, Stein-Parbury J, Luscombe G, et al. PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia. Int Psychogeriatr. 2014;26(7): 1147-60. doi:10.1017/S1041610214000398.

Lin R, Chen HY, Li H, Li J. Effects of creative expression therapy on Chinese elderly patients with dementia: an exploratory randomized controlled trial. Neuropsychiatr Dis Treat. 2019;15: 2171-80. doi:10.2147/NDT.S200045.

Luo H, Lou VWQ, Chen C, Chi I. The effectiveness of the positive mood and active life program on reducing depressive symptoms in long-term care facilities. Gerontologist. 2020;60(1):193-204. doi:10.1093/geront/gny120.

O’Shea E, Devane D, Cooney A, Casey D, Jordan F, Hunter A, et al. The impact of reminiscence on the quality of life of residents with dementia in long-stay care. Int J Geriatr Psychiatry. 2014 ;29(10):1062-70. doi:10. 1002/ gps.4099.

Pramesona BA, Taneepanichskul S. The effect of religious intervention on depressive symptoms and quality of life among Indonesian elderly in nursing homes: a quasi-experimental study. Clin Interv Aging. 2018;13:473-83. doi:10. 2147/CIA.S162946.

Serrani Azcurra DJL. A reminiscence program intervention to improve the quality of life of long-term care residents with Alzheimer’s disease: a randomized controlled trial. Braz J Psychiatry. 2012;34(4):422-33. doi:10.1016/j. rbp.2012.05.008.

van Dijk AM, van Weert JCM, Dröes RM. Does theatre improve the quality of life of people with dementia? Int Psychogeriatr. 2012;24(3):367-81. doi: 10.1017/ S1041610211001992.

Keyes CLM. The mental health continuum: from languishing to flourishing in life. J Health Soc Behav. 2002;43(2): 207-22. doi:10.2307/3090197.

Westerhof GJ, Keyes CLM. Mental illness and mental health: the two continua model across the lifespan. J Adult Dev. 2010;17(2):110–9. doi:10.1007/s10804-009-9082-y.

Thomas JM, Sezgin D. Effectiveness of reminiscence therapy in reducing agitation and depression and improving quality of life and cognition in long-term care residents with dementia: a systematic review and meta-analysis. Geriatr Nurs. 2021; 42(6):1497-506. doi:10.1016/j.gerinurse.2021.10.014.

Park K, Lee S, Yang J, Song T, Hong GS. A systematic review and meta-analysis on the effect of reminiscence therapy for people with dementia. Int Psychogeriatr. 2019;31(11): 1581-97. doi:10.1017/S1041610218002168.

Diegelmann M, Wahl HW, Schilling OK, Jansen CP, Schnabel EL, Hauer K. Understanding depressive symptoms in nursing home residents: the role of frequency and enjoyability of different expanded everyday activities relevant to the nursing home setting. Eur J Ageing. 2018;15(4):339-48. doi:10.1007/s10433-017-0453-0.

Chu H, Yang CY, Lin Y, Ou KL, Lee TY, O’Brien AP, et al. The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study. Biol Res Nurs. 2014;16(2):209-17. doi:10.1177/1099800413485410.

Downloads

Published

2023-09-28

How to Cite

1.
Ngamwongwiwat B, Kongsuwan V, Songwathana P. Interventions for Improving Mental Health and Quality of Life of Older Adults with Mental Illness in Long-term Care: A Systematic Review and Meta-analysis. PRIJNR [Internet]. 2023 Sep. 28 [cited 2024 Oct. 6];27(4):671-93. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/261505