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Updated: October 5, 2020

What are the ways that long-term care homes can improve the psycho-social well-being of residents in the context of pandemic restrictions?

Summary

The following is a summary of evidence sources that provide high quality information on the impacts of COVID-19 on the psycho-social well-being of long-term care home residents. For additional information about each of the sources, see the Table below.

A commentary on  ‘Age and ageism in COVID-19’: Elderly mental health-care vulnerabilities and needs  notes that various mental-health issues are expected to surge in the months following the pandemic, with a significant proportion of them being in the elderly population [6]. The authors also note that loneliness is a risk factor for depression and cognitive disorders, especially when chronic and associated with a lack of physical activity, and that any form of stress is associated with decreased immunity [6]. Another commentary suggests that social isolation among older adults will be felt more in disadvantaged and marginalised populations [4].  
 
To increase psycho-social wellbeing among the elderly population while maintaining physical distancing, a combination of strategies is recommended. According to guidance from Ottawa Public Health Protecting Your Mental Health: What you can do as an older adult? and several resources, older adults should try to: 1) do crossword puzzles, sudoku or puzzles; 2) read books or newspapers; 3) write or journal thoughts, stories, list or poems; 4) draw, paint or colour; 5) watch documentaries, television, movies or listen to music; 6) meditate, practice gratitude or pray; 7) call or videoconference family or friends; 8) knit, sew or try needlepoint; 9) stretch or do exercises designed for older adults; 10) declutter your room or home; 11) try to maintain as normal of a schedule as possible; and 12) stay connected to clinical services and support through telehealth wherever possible [4,5,6,8,9]. Having residents sort items such as buttons or cards and thanking them for them for completing these tasks may help residents feel they are needed [7]. A review of 15 Smartphone Apps for Older Adults to Use While in Isolation During the COVID-19 Pandemic describes how mobile technology such as applications (apps) can help older adults stay connected to loved ones, maintain mobility, help to supplement and substitute in-person care and link older adults to resources that encourage physical and mental well-being [1]. However, a commentary on the COVID-19 and the consequences of isolating the elderly notes that many disparities exist with regards to access to technology and literacy in digital resources [4]. In addition to communication using technology, the Government of Canada also recommends communication through the window of a resident’s room such as by having family members show signs or sing, and also by encouraging families to send cards or letters as long as no one in the household is ill [3, 7]. If family members are unavailable, recruiting volunteers to call residents and Simulated Presence Therapy is recommended [7].  
 
Furthermore, the Psychological First Aid Field Operation Guide for Nursing Homes, Second Edition book suggests that all nursing home staff should be trained to use Psychological First Aid techniques to increase the likelihood that appropriate mental health interventions are provided to any residents or staff in need [8]. A commentary on  Achieving Safe, Effective, and Compassionate Quarantine or Isolation of Older Adults With Dementia in Nursing Homes notes that decisions that affect nursing home residents should balance individuals’ rights with collective safety, address fairness and justice, and provide transparency and accountability in decision making to maintain public trust [3].  
 
One report emphasizes the need to monitor the psychological state of nursing home residents [10]. It recommends assessing subtle signs of change in mental health status of residents, offering emotional support to all residents not just those with a prior mental health history and to pay special attention to residents who have a history of mental health illness or trauma [10].  
 

Evidence

What‘s Trending on Social Media and Media

The Registered Nurses’ Association of Ontario has released three platforms that provide support for long-term care and retirement homes. To help families cope with the impact of the current visiting restrictions within long-term care (LTC) homes, a “Connecting Families” Facebook group was created. This platform provides individuals with a forum to connect and receive support from others in similar situations. To help nurses and other healthcare professionals share experiences and strategies to cope with challenges in LTC homes, a Facebook group called “Sharing and Tackling Emerging Care Issues Together” was created in addition to a “Peer-to-Peer Support” group. 

Organizational Scan

The Ontario Centres for Learning, Research & Innovation in Long-Term Care (LTC) has created a province-based collated list of resources for LTC leaders and team members during COVID-19. These resources focus on the health and well-being of residents and include: a Virtual Visits Toolkit, which aims to help residents stay connected with family and friends during social isolation, and Boredom Busters for LTC, which is a list of resources for recreation professionals to help minimize boredom and loneliness for residents living LTC homes [11].  
  
The Canadian Coalition for Seniors Mental Health provides a list of mental health support lines for seniors in Canada that offer advice, information and counselling services to those in need [12].  
 
The National Initiative for the Care of the Elderly (NICE) offers free the Talk 2 NICE service where social workers provide, by phone, free outreach and brief counselling services for older adults and persons with disabilities [13]
 

Review of Evidence

Resource Type/Source of Evidence Last Updated
15 Smartphone Apps for Older Adults to Use While in Isolation During the COVID-19 Pandemic
— Banskota et al.
Rapid Review

This review notes that mobile technology such as applications (apps) can help older adults stay connected, maintain mobility and link them to resources that encourage physical and mental well-being. The recommended apps can supplement and substitute in-person care, decrease loneliness and maintain health and independence. These apps are inexpensive, accessible and require minimal training.

This review provides a list of 15 apps for older adults for social networking, telemedicine, prescription management, health and fitness, food and drink and visual and hearing-impairment.

Last Updated: April 30, 2020
Interim guidance: Care of residents in long term care homes during the COVID-19 pandemic
— Government of Canada
National Guidance

This guidance states that social interaction and recreational activities should continue where feasible and abiding by public health guidance, dependent on local COVID-19 epidemiology. If there is an outbreak or residents are infected with COVID-19, activities may be conducted one-on-one or virtually. If possible, long term care homes should provide smartphones or tablets to residents resident (if shared, disinfected between uses) and free internet. Alternative methods of family contact , e.g. phone or video, communication through the window such as by showing signs or singing, and encouraging families to send cards or letters if no one in the household is ill. Online viewing of religious services is recommended.  

Last Updated: July 16, 2020
Achieving Safe, Effective, and Compassionate Quarantine or Isolation of Older Adults With Dementia in Nursing Homes
— Iaboni et al.
Commentary

This commentary notes that no guidelines exist that directly address the practical challenges faced when trying to isolate people with dementia effectively while maintaining their safety and human dignity. Decisions that affect residents should balance individuals’ rights with collective safety, address fairness and justice, and provide transparency and accountability in decision making to maintain public trust.

Last Updated: May 3, 2020
COVID-19 and the consequences of isolation the elderly
— Armitage et al.
Commentary

This report notes that online technologies could be used to provide social support networks and a sense of belonging, although many disparities exist with regards to access or literacy in digital resources. Interventions could involve more frequent telephone contact with family and friends, voluntary organisations or healthcare professionals or community outreach projects that provide peer support.

This report notes that social isolation among elderly people will be felt most in more disadvantages and marginalised populations.

Last Updated: March 18, 2020
Things to do While Physical-Distancing
— Canadian Coalition for Seniors' Mental Health
Guidance

This resource offers a list of activities older adults can do to remain social and active while physical-distancing. These activities include: 1) crossword puzzles, sudoku or puzzles; 2) reading books or newspapers; 3) writing or journaling thoughts, stories, list or poems; 4) drawing, painting or colouring; 5) watching documentaries, television, movies or listening to music; 6) meditating or practicing gratitude; 7) calling or videoconferencing family or friends; 8) knitting, sewing or trying needlepoint; 9) stretching or doing exercises designed for older adults; 10) decluttering your room or home.  

Last Updated: June 15, 2020
‘Age and ageism in COVID-19’: Elderly mental health-care vulnerabilities and needs
— Banerjee, Debanjan
Commentary

This commentary notes that all forms of stress are associated with decreased immunity. Loneliness is a potential risk factor for depression and cognitive disorders, especially when chronic and associated with lack of physical activity. 

This commentary identifies some  measures to ensure psychological well-being including : 1) maintaining and increasing social connectedness with loved ones; 2) promoting tele-facilities for health care consultation; 3) reducing digital screen time to prevent misinformation and panic; 4) promoting physical activity and ensuring nutrition; and 5) preserving autonomy, respect and dignity among geriatric populations through their active involvement in decision making.

This report notes that various mental-health issues are expected to surge in the post-pandemic months with a significant proportion of them might be the elderly.

Last Updated: May 31, 2020
Loneliness and Isolation in Long-term Care and the COVID-19 Pandemic
— Simard & Volicier
Editorial

This editorial provides recommendations that require little or no cost or hiring of additional staff. These include: 1) using name tags that can be easily read to help build connections; 2) having family members or residents to purchase personal computers or iPads for communication; 3) asking families to call in mornings and evenings or recruiting volunteers to call residents; 4) having families come to the window of a resident’s room, urging families to send cards and letters; 5) providing realistic toys such as dogs, cats or dolls to comfort residents with dementia; 6) using Simulated Presence Therapy; and 7) providing activities such as sorting items and thanking residents so that they feel they are needed. 

Last Updated: May 7, 2020
Psychological First Aid Field Operation Guide for Nursing Homes, Second Edition
— Brown et al.
Book

This book describes how the use of Psychological First Aid techniques in nursing homes is an ideal intervention for staff to learn and use with distressed residents and staff. All nursing home staff should be training to use psychological first aid increases the likelihood that appropriate mental health interventions are provided to those in need. 

This book recommends the following adaptive coping actions to recommend to nursing home residents: 1) getting adequate rest, nutrition and exercise; 2) engaging in positive distracting activities such as hobbies and reading; 3) engaging in meditation or prayer; 4) trying to maintain as normal of a schedule as possible; 5) getting needed information; and 6) keeping a journal or using calming self-talk.

Last Updated: January 31, 2019
Protecting Your Mental Health: What you can do as an older adult?
— Ottawa Public Health
Guidance

This guidance recommends that older adults can try using technology to reach out to friends and family. This resource provides links for adults to learn about their technology, phone numbers to call for emotional and clinical support and technology that is available to connect to the outside world (i.e. access to museums, art galleries, exercise classes, magazine, etc.).

Last Updated: June 15, 2020
Tips to ensure your residents’ mental health needs are met during the COVID-19 pandemic
— Lind, Lisa
Background Information

This article suggests some tips in monitoring the needs of nursing facility residents. These include assessing subtle signs of change in mental health status of residents, offering emotional support to all residents not just those with a prior mental health history and to pay attention to your residents who have a history or trauma.

Last Updated: May 3, 2020
Supports for LTC Team Members during COVID-19
— Ontario Centres for Learning, Research & Innovation in Long-Term Care
Organizational Scan Last Updated: June 10, 2020
Mental Health Support Lines for Seniors in Canada
— Canadian Coalition for Seniors' Mental Health
Organizational Scan Last Updated: June 10, 2020
Talk 2 NICE
— National Initiative for the Care of the Elderly
Organizational Scan Last Updated: June 10, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.

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