Quality of life survey highlights need for holistic approach in elderly residential care

14 may 2009--Choice, privacy and a sense of identity are just some of the things that older people living in residential care need to maintain a good quality of life, according to research in the May issue of the Journal of Advanced Nursing.

Researchers from the National University of Ireland (NUI), Galway, spoke to 101 older people living in 12 long-stay care homes, including small and large facilities, well-established and recently built homes and those provided by the public, private and voluntary sectors.

They found that four key themes had an impact on the subjects' quality of life: the ethos of care provided by the home, the residents' sense of self and identity, how connected they felt and the activities and therapies they got involved in.

"It was clear from our research that practitioners and policy makers need to take all these factors into account if they are to provide older people with the sort of residential care that enhances their quality of life" says lead author Dr Adeline Cooney, from the School of Nursing and Midwifery at the University.

"We also found that residents tended to be happier if they had been involved in the decision to move into residential care, as they were more likely to make the best of it, getting involved in activities and making friends. People who were not involved in the decision tended to withdraw into themselves and were more likely to be lonely, unhappy and keen to return home."

Two-thirds of the residents who took part in the study were male. All were 65 or over and the majority of residents (45 per cent) fell into the 75-84 age group and had been in residential care for two to four years (37 per cent).

Key findings included:

• Participants said choice was important when it came to their daily routine. "I can go to bed anytime I like" one said positively, while another complained that "you're woken at six and breakfast isn't until ten past eight."
• People valued the opportunity to make their surroundings more familiar. "This is my own furniture" said one, while another complained she was unable to have her computer with her because "there is no space".
• Privacy was also important and even people who had their own rooms said staff tended to barge in without knocking. Others felt it even more acutely. "There's nowhere to get away on your own" said a resident in a shared room.
• Residents liked it when they felt valued by staff and their expertise or skills were drawn on. Some facilities formally involved residents in collective decision making, but not all. One resident spoke about how she loved gardening and had joined the committee to set one up at her residential home.
• Feeling connected to family, the community and the outside world was also important. "If I couldn't keep in contact with the outside world where would I be?" said one participant, while another said of fellow residents "it's not like your family, but you make them your family."
• Residents who were not provided with regular and varied activities often felt frustrated and disengaged. One resident said it was "just the same thing, the same day in and day out…it's boring".
• Residents valued the chance to get out and keep in touch. This could be a simple shopping trip, a visit to family or an event such as a day trip or barbecue. But lack of independence and mobility often restricted how often they were able to go out.
• Previous life experiences also shaped how well people settled in. For example, one resident didn't want to make friends because the other residents were from a "poorer class" and regarded her as too "swanky" for them.
• Health status also had an important effect on quality of life and some residents said their health had deteriorated since they moved in. Important therapies were not always available. "The physiotherapy I was getting just stopped" said one participant.
• Other factors that affected quality of life included the physical condition and homeliness of the facility, the friendliness of the staff, the openness of the visiting policy and strong links with the local community.

"This study highlights the importance of providing a holistic, person-centred approach that goes beyond satisfying the technical and procedural aspects of care" concludes Dr Cooney.

"Care staff should regard the quality of life of residents as an integral part of their role and residents and their families should have significant input into how services are structured and delivered.

"Although this study was carried out in Ireland, the basic principles of how the quality of life of older people in residential care can be enhanced are universal."

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The study, which was funded by the National Council for Ageing and Older People, was led by Professor Kathy Murphy from the School of Nursing and Midwifery and Professor Eamon O'Shea from the Irish Centre for Social Gerontology, both at NUI Galway.

Notes to editors

Resident perspectives of the determinants of quality of life in residential care in Ireland. Cooney et al. Journal of Advanced Nursing. 65.5, 1029-1038. (May 2009).