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Understanding the Barriers to and Facilitators of Anxiety Management in Residents of Long-Term Care

Published online by Cambridge University Press:  04 September 2023

Kayla Atchison Open the ORCID record for Kayla Atchison [Opens in a new window] ,
Ann M. Toohey Open the ORCID record for Ann M. Toohey [Opens in a new window] ,
Zahinoor Ismail  and
Zahra Goodarzi Open the ORCID record for Zahra Goodarzi [Opens in a new window]
Kayla Atchison
Affiliation:
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
Ann M. Toohey
Affiliation:
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada Brenda Strafford Centre on Aging, University of Calgary, Calgary, AB, Canada
Zahinoor Ismail
Affiliation:
Department of Psychiatry, University of Calgary and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
Zahra Goodarzi*
Affiliation:
Department of Medicine, University of Calgary, Calgary, AB, Canada
*
Corresponding author: La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Zahra Goodarzi, M.D., M.Sc., F.R.C.P.C. Department of Medicine University of Calgary South Tower, Room 1104 1403-29 St NW Calgary, Alberta, T2N 2T9 Canada (zahra.goodarzi@albertahealthservices.ca).
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Abstract

Older adults, 65 years of age and older, living in long-term care (LTC) commonly experience anxiety. This study aimed to understand care providers’ perspectives on the barriers to and facilitators of managing anxiety in residents of LTC. Ten semi-structured interviews with care providers in LTC were completed. Framework analysis methods were used to code, thematically analyze, designate codes as barriers or facilitators, and map the codes to the Theoretical Domains Framework. Themes were categorized as acting at the resident, provider, or system level, and were labelled as either barriers to or facilitators of anxiety care. Key barriers to anxiety care at each level were resident cognitive impairment or co-morbidities; lack of staff education, staff treatment uptake and implementation; as well as the care delivery environment and access to resources. There is a need to prioritize measurement-based care for anxiety, have increased access to non-pharmacological treatments, and have a care delivery environment that supports anxiety management to improve the care for anxiety that is delivered to residents.

Résumé

Résumé

Les personnes âgées qui vivent dans des établissements de soins de longue durée souffrent souvent d’anxiété. Cette étude vise à comprendre les points de vue des fournisseurs de soins à propos des obstacles et des facteurs de facilitation inhérents à la prise en charge de l’anxiété chez les résidents d’établissements de soins de longue durée. Nous avons mené dix entrevues semi-structurées avec des fournisseurs de soins dans des établissements de soins de longue durée. Des méthodes d’analyse du cadre ont été utilisées pour classer les obstacles et les facteurs de facilitation par thème, les coder et en établir la correspondance avec le Cadre des domaines théoriques (Theoretical Domains Framework – TDF). Les thèmes ont été catégorisés en trois niveaux opératoires : résident, fournisseur ou système, et les facteurs ont été étiquetés comme des obstacles à, ou des facilitateurs de, la prise en charge de l’anxiété. Les principaux obstacles à la prise en charge de l’anxiété à chacun des niveaux étaient le déficit cognitif ou ses comorbidités chez les résidents, la formation du personnel, l’adoption et la mise en œuvre du traitement par le personnel, l’environnement de prestation de soins et l’accès aux ressources. Afin d’améliorer la prestation de soins axée sur l’anxiété chez les résidents, il est nécessaire de prioriser la prise en charge de l’anxiété basée sur des paramètres, d’accroître l’accès aux traitements non pharmacologiques et de favoriser le développement d’un environnement de prestation de soins qui soutient la prise en charge de l’anxiété.

Keywords

aginganxietylong-term carequalitativevieillissementanxiétésoins de longue duréeanalyse qualitativeprise en charge de l’anxiétérésidentsfournisseurs de soinsenvironnement de prestation de soins
Type
Article
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 43 , Issue 1 , March 2024 , pp. 57 - 74
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Copyright
© Canadian Association on Gerontology 2023

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References

Abraham, C., Kelly, M. P., West, R., & Michie, S. (2009). The UK National Institute for Health and Clinical Excellence public health guidance on behaviour change: A brief introduction. Psychology, Health & Medicine, 14(1), 1–8. https://doi.org/10.1080/13548500802537903CrossRefGoogle ScholarPubMed
Alberta Health Services. (2020). Continuing care pandemic operational guide (COVID-19). Retrieved 2 November 2021 from https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-cc-pandemic-influenza-operational-guide.pdfGoogle Scholar
Alp, F. Y., & Yucel, S. C. (2020). The effect of therapeutic touch on the comfort and anxiety of nursing home residents. Journal of Religion and Health, 60(3), 2037–2050. https://doi.org/10.1007/s10943-020-01025-4CrossRefGoogle Scholar
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Publishing.Google Scholar
An, Q., Wang, K., Sun, F., & Zhang, A. (2020). The effectiveness of modified, group-based CBT for dementia worry among Chinese elders. Journal of Affective Disorders, 274, 76–84. https://doi.org/10.1016/j.jad.2020.05.054CrossRefGoogle ScholarPubMed
Arlinghaus, K. R., & Johnston, C. A. (2018). Advocating for behavior change with education. American Journal of Lifestyle Medicine, 12(2), 113–116. https://doi.org/10.1177/1559827617745479CrossRefGoogle ScholarPubMed
Atchison, K., Shafiq, S., Ewert, D., Leung, A., & Goodarzi, Z. (2022). Detecting anxiety in long-term care residents: A systematic review. Canadian Journal on Aging, 42, 92–101. doi:10.1017/S0714980822000101CrossRefGoogle ScholarPubMed
Atchison, K., Watt, J. A., Ewert, D., Toohey, A. M., Ismail, Z., & Goodarzi, Z. (2022). Non-pharmacologic and pharmacologic treatments for anxiety in long-term care: A systematic review and meta-analysis. Age and Ageing, 51, afac195. https://doi.org/10.1093/ageing/afac195CrossRefGoogle ScholarPubMed
Bor, J. S. (2015). Among the elderly, many mental illnesses go undiagnosed. Health Affairs, 34, 727–731. https://doi.org/10.1377/hlthaff.2015.0314CrossRefGoogle ScholarPubMed
Brodaty, H., Draper, B. M., & Low, L. F. (2003). Behavioural and psychological symptoms of dementia: A seven‐tiered model of service delivery. Medical Journal of Australia, 178(5), 231–234. https://doi.org/10.5694/j.1326-5377.2003.tb05169.xCrossRefGoogle ScholarPubMed
Canadian Institute for Health Information. (2020). Profile of residents in residential and hospital-based continuing care, 2019–2020 — Quick stats. Retrieved 2 November 2021 from https://www.cihi.ca/sites/default/files/document/ccrs-quick-stats-2019-2020-en.xlsxGoogle Scholar
Canadian Institute for Health Information. (2021). The Impact of COVID-19 on long-term care in Canada: Focus on the first 6 months. Retrieved 2 November 2021 from https://www.cihi.ca/sites/default/files/document/impact-covid-19-long-term-care-canada-first-6-months-report-en.pdfGoogle Scholar
Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7(1), 37. https://doi.org/10.1186/1748-5908-7-37CrossRefGoogle ScholarPubMed
Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 73. https://doi.org/10.3389/fneur.2012.00073CrossRefGoogle ScholarPubMed
Costa, F., Ockelford, A., & Hargreaves, D. J. (2018). The effect of regular listening to preferred music on pain, depression and anxiety in older care home residents. Psychology of Music, 46(2), 174–191. https://doi.org/10.1177/0305735617703811CrossRefGoogle Scholar
Creighton, A. S., Davison, T. E., & Kissane, D. W. (2016). The prevalence of anxiety among older adults in nursing homes and other residential aged care facilities: A systematic review. International Journal of Geriatric Psychiatry, 31(6), 555–566. https://doi.org/10.1002/gps.4378CrossRefGoogle ScholarPubMed
Creighton, A. S., Davison, T. E., & Kissane, D. W. (2018). The prevalence, reporting, and treatment of anxiety among older adults in nursing homes and other residential aged care facilities. Journal of Affective Disorders, 227, 416–423. https://doi.org/10.1016/j.jad.2017.11.029CrossRefGoogle ScholarPubMed
Creighton, A. S., Davison, T. E., & Kissane, D. W. (2019). The psychometric properties, sensitivity and specificity of the Geriatric Anxiety Inventory, Hospital Anxiety and Depression Scale, and Rating Anxiety in Dementia Scale in aged care residents. Aging & Mental Health, 23(5), 633–642. https://doi.org/10.1080/13607863.2018.1439882CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The neuropsychiatric inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44(12), 2308–2314. https://doi.org/10.1212/WNL.44.12.2308CrossRefGoogle ScholarPubMed
Ellis, M. L., Molinari, V., Dobbs, D., Smith, K., & Hyer, K. (2015). Assessing approaches and barriers to reduce antipsychotic drug use in Florida nursing homes. Aging & Mental Health, 19(6), 507–516. https://doi.org/10.1080/13607863.2014.952710CrossRefGoogle ScholarPubMed
Ergin, E., & Yücel, Ş. Ç. (2019). The effect of music on the comfort and anxiety of older adults living in a nursing home in Turkey. Journal of Religion and Health, 58(4), 1401–1414. https://doi.org/10.1007/s10943-019-00811-zCrossRefGoogle Scholar
Fagundes, D. F., Costa, M. T., da Silva Alves, B. B., Benício, M. M. S., Vieira, L. P., Carneiro, L. S., et al. (2021). Prevalence of dementia in long-term care institutions: A meta-analysis. Jornal Brasileiro de Psiquiatria, 70(1), 59–67. https://doi.org/10.1590/0047-2085000000298CrossRefGoogle Scholar
Fjær, E. G., & Vabø, M. (2013). Shaping social situations: A hidden aspect of care work in nursing homes. Journal of Aging Studies, 27(4), 419–427. https://doi.org/10.1016/j.jaging.2013.10.002CrossRefGoogle ScholarPubMed
Fraser, J., & Kerr, J. R. (1993). Psychophysiological effects of back massage on elderly institutionalized patients. Journal of Advanced Nursing, 18(2), 238–245. https://doi.org/10.1046/j.1365-2648.1993.18020238.xCrossRefGoogle ScholarPubMed
Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13(1), 117. https://doi.org/10.1186/1471-2288-13-117CrossRefGoogle ScholarPubMed
Garcia, L. J., Hébert, M., Kozak, J., Sénécal, I., Slaughter, S. E., Aminzadeh, F., et al. (2012). Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia. International Psychogeriatrics, 24(5), 753–765. doi:10.1017/S1041610211002675CrossRefGoogle ScholarPubMed
Government of Alberta. (2017). 2015/2016 Long-term care resident profile. Retrieved 25 April 2021 from https://open.alberta.ca/publications/alberta-long-term-care-resident-profile.Google Scholar
Government of Alberta (2022). COVID-19 Information, questions & answers: COVID-19 requirements for licensed supportive living, long-term care and hospice settings. Retrieved 13 July 2023 from https://open.alberta.ca/dataset/f7f40446-b0a7-4053-bba6-4b15bd14b588/resource/acf9930b-106c-46e1-9c8e-bef0cd3350ee/download/covid-19-faq-requirements-licensed-supportive-living-long-term-care-hospice-settings-2022-02.pdfGoogle Scholar
Goyal, A. R., Bergh, S., Engedal, K., Kirkevold, M., & Kirkevold, Ø. (2017). Norwegian version of the rating anxiety in dementia scale (RAID-N): A validity and reliability study. Aging & Mental Health, 21(12), 1256–1261. https://doi.org/10.1080/13607863.2016.1220921CrossRefGoogle ScholarPubMed
Goyal, A. R., Bergh, S., Engedal, K., Kirkevold, M., & Kirkevold, Ø. (2018). Trajectories of quality of life and their association with anxiety in people with dementia in nursing homes: A 12-month follow-up study. PLoS One, 13(9), e0203773. https://doi.org/10.1371/journal.pone.0203773CrossRefGoogle ScholarPubMed
Green, J., & Thorogood, N. (2018). Qualitative methods for health research. Washington, DC: SAGE.Google Scholar
Guetin, S., Portet, F., Picot, M., Pommié, C., Messaoudi, M., Djabelkir, L., et al. (2009). Effect of music therapy on anxiety and depression in patients with Alzheimer’s type dementia: Randomised, controlled study. Dementia and Geriatric Cognitive Disorders, 28(1), 36–46. https://doi.org/10.1159/000229024CrossRefGoogle ScholarPubMed
Helmes, E., & Ward, B. G. (2017). Mindfulness-based cognitive therapy for anxiety symptoms in older adults in residential care. Aging & Mental Health, 21(3), 272–278. https://doi.org/10.1080/13607863.2015.1111862CrossRefGoogle ScholarPubMed
Ikemata, S., & Momose, Y. (2017). Effects of a progressive muscle relaxation intervention on dementia symptoms, activities of daily living, and immune function in group home residents with dementia in Japan. Japan Journal of Nursing Science, 14(2), 135–145. https://doi.org/10.1111/jjns.12147Google ScholarPubMed
Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., & Van Ameringen, M. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14(S1), 1–83. https://doi.org/10.1186/1471-244X-14-S1-S1CrossRefGoogle ScholarPubMed
Koychev, I., & Ebmeier, K. (2016). Anxiety in older adults often goes undiagnosed. Practitioner, 260(1789), 17–20.Google ScholarPubMed
Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., Walker, A., et al. (2005). Making psychological theory useful for implementing evidence based practice: A consensus approach. BMC Quality and Safety, 14(1), 26–33. http://doi.org/10.1136/qshc.2004.011155CrossRefGoogle ScholarPubMed
Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42. https://doi.org/10.1186/1748-5908-6-42CrossRefGoogle ScholarPubMed
Mohammadi, A. Z. (2011). An evaluation of the effect of group music therapy on stress, anxiety, and depression levels in nursing home residents. Canadian Journal of Music Therapy, 17(1), 55–68.Google Scholar
Patton, M. Q. (1990). Qualitative evaluation and research methods. Washington, DC: SAGE.Google Scholar
Peizhen, C., Shuming, C., & Huixian, L. (2020). The effect of mindfulness decompression on migration anxiety and adjustment of elderly people with diabetes in institutions. Journal of Nursing, 67(2), 45–57. doi: 10.6224/JN.202004_67(2).07Google Scholar
Pifer, M. A., Segal, D. L., Jester, D. J., & Molinari, V. (2020). Assessment of anxiety in long-term care residents: Issues and strategies. International Journal of Aging and Human Development, 93, 807–833. https://doi.org/10.1177/0091415020943321CrossRefGoogle Scholar
Prakash, P., Seran, N., & Thilakan, P. (2019). The effectiveness of TIPER (Tailor Made Interventional Package to Enhance Relaxation) on depression, anxiety and stress among elders at old age homes, Puducherry. International Journal of Research in Pharmaceutical Sciences, 10(2), 1124–1126.CrossRefGoogle Scholar
QSR International Pty Ltd. (2020). NVivo (Version 12, released in March 2020). https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/homeGoogle Scholar
Raglio, A., Bellelli, G., Traficante, D., Gianotti, M., Ubezio, M. C., Villani, D., et al. (2008). Efficacy of music therapy in the treatment of behavioral and psychiatric symptoms of dementia. Alzheimer Disease & Associated Disorders, 22(2), 158–162. 10.1097/WAD.0b013e3181630b6fGoogle ScholarPubMed
Rezola-Pardo, C., Arrieta, H., Gil, S. M., Zarrazquin, I., Yanguas, J. J., López, M. A., et al. (2019). Comparison between multicomponent and simultaneous dual-task exercise interventions in long-term nursing home residents: The ageing-ONDUAL-TASK randomized controlled study. Age and Ageing, 48(6), 817–823. https://doi.org/10.1093/ageing/afz105CrossRefGoogle ScholarPubMed
Rezola-Pardo, C., Rodriguez-Larrad, A., Gomez-Diaz, J., Lozano-Real, G., Mugica-Errazquin, I., Patiño, M. J., et al. (2020). Comparison between multicomponent exercise and walking interventions in long-term nursing homes: A randomized controlled trial. Gerontologist, 60(7), 1364–1373. https://doi.org/10.1093/geront/gnz177CrossRefGoogle ScholarPubMed
Shankar, K., Walker, M., Frost, D., & Orrell, M. (1999). The development of a valid and reliable scale for rating anxiety in dementia (RAID). Aging & Mental Health, 3(1), 39–49. https://doi.org/10.1080/13607869956424CrossRefGoogle Scholar
Simington, J. A., & Laing, G. P. (1993). Effects of therapeutic touch on anxiety in the institutionalized elderly. Clinical Nursing Research, 2(4), 438–450. https://doi.org/10.1177/105477389300200406CrossRefGoogle ScholarPubMed
Smalbrugge, M., Pot, A. M., Jongenelis, L., Gundy, C. M., Beekman, A. T., & Eefsting, J. A. (2006). The impact of depression and anxiety on well being, disability and use of health care services in nursing home patients. International Journal of Geriatric Psychiatry, 21(4), 325–332. https://doi.org/10.1002/gps.1466CrossRefGoogle ScholarPubMed
Sung, H. C., Chang, A. M., & Lee, W. L. (2010). A preferred music listening intervention to reduce anxiety in older adults with dementia in nursing homes. Journal of Clinical Nursing, 19(7–8), 1056–1064. https://doi.org/10.1111/j.1365-2702.2009.03016.xCrossRefGoogle ScholarPubMed
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042CrossRefGoogle ScholarPubMed
Wood, S., Cummings, J. L., Hsu, M.-A., Barclay, T., Wheatley, M. V., Yarema, K. T., et al. (2000). The use of the neuropsychiatric inventory in nursing home residents: Characterization and measurement. American Journal of Geriatric Psychiatry, 8(1), 75–83. https://doi.org/10.1097/00019442-200002000-00010CrossRefGoogle ScholarPubMed
Yücel, Ş. Ç., Arslan, G. G., & Bagci, H. (2020). Effects of hand massage and therapeutic touch on comfort and anxiety living in a nursing home in Turkey: A randomized controlled trial. Journal of Religion and Health, 59(1), 351–364. https://doi.org/10.1007/s10943-019-00813-xCrossRefGoogle Scholar
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