Quality of Life in Nursing Homes

Nursing homes provide residence for over a million people worldwide. They can prove advantageous for older individuals suffering from physical or cognitive impairment. Nursing homes provide advanced, around-the-clock care and can attend to patients more readily than other healthcare centers. Along with this, they offer social events to remove strict isolation between patients. However, residents often live a structured lifestyle. They are typically not provided with autonomy over daily activities and interactions, preventing them from regularly seeing friends and family. While many reviews and literature study the effect of nursing homes on clinical and financial outcomes, they frequently disregard the quality of life of the patient. Quality of life is hard to quantify and is typically subjective to individuals. Patient’s social interactions, intrinsic motivation, sense of security, satisfaction, physical well-being etc., all need to be accounted for under this umbrella term. With this being said, there are ways to measure the quality of life of an individual. 

A cross-sectional study in Norway accomplished this task through the Norwegian Quality of Life in Late-Stage Dementia (QUALID) scale. In this, sleep patterns, physical activity, psychotropic medications, and many other factors were monitored (Olsen, 2016). Individuals who scored lower on the scale were recorded to have a greater quality of life than patients who scored higher. The purpose of this study was to compare the quality of life between individuals with dementia residing in a nursing home versus at home. The severity of dementia varied between the two residences, with nursing homes containing patients with a higher severity of dementia than home individuals. To combat this bias, the researchers performed a stratified analysis (Olsen, 2016). In their findings, they noticed that patients residing at home had a significantly higher quality of life than nursing home patients, scoring a 0.719 and 0.764 on the QUALID scale respectively (Olsen, 2016). The values had a Cronbach’s alpha of 0.815, meaning there is good reliability of variance between these two values. Overall, nursing home patients recorded fewer social interactions, lower sleep levels, lower activity levels, 4x less light exposure, more psychotropic medication, and more guided physical movement (Olsen, 2016). While this study only highlighted dementia patients, persons with dementia mimic prime examples of the “average” nursing home resident. Individuals with dementia struggle with physical and cognitive function and require constant assistance from medical personnel, like many nursing home individuals. Due to these commonalities, the generalization can be made that nursing homes patients have a lower quality of life than at-home patients.

In hopes to positively shift the quality of life of nursing home residents, a study was performed to test the effects of culture change practices on nursing homes. Specifically, environments provided more opportunities for resident engagement, focused on staff empowerment, and worked to improve individual’s sense of security (Duan, 2020). Quality of life was measured using the Social Production Function theory, scoring patient’s overall perception of life, physical well-being, stimulation, psychosocial stage, feelings of autonomy, behavioral confirmation status, and affection levels (Duan, 2020). In total, culture change indicated a positive effect on the individual’s quality of life. Individuals were reported to have more satisfaction with care, life, and autonomy. In creating a home-like environment, residents’ preferences were more fulfilled (Duan, 2020). This shift in way of living speaks numbers for the future of nursing home care. By prioritizing a patient's simple desires, the quality of life of the patient can significantly increase. 

Overall, nursing homes can be a beneficial option for many individuals. However, alterations need to be implemented into the healthcare system to improve the quality of life of nursing home residents. Universities can work to educate nurses on the mental health of nursing home patients. In general, nursing home patients show little to no fear in passing away (Sandgren, 2020). By knowing this, nurses can spark this difficult conversation to find out the preferences of the individual before reaching this time. This strengthens the connection between nurse and patient, allowing nurses to better accommodate the patient’s needs. Additionally, individuals above the age of 80 show rising interest in connecting with greater beings (Haugan, 2016). The search for fulfillment can be promoted by self-confidence. If nurses are instructed to instill this confidence in patients, it will facilitate the patient's spiritual journey, allowing them to feel more at ease in their physical and mental state (Haugan, 2016). Finally, it has been proven that individuals prefer staying in a familiar environment (Sandgren, 2020). By allowing individuals to continue indulging in their daily habits, nursing homes and facilities can become a place of comfort and familiarity for patients. Moreover, individuals should be provided autonomy over everyday activities to maintain more control over their day-to-day life. With small changes in the healthcare system, the quality of life of patients in nursing homes should drastically increase in the near future. 

References

Duan, Y., Mueller, C. A., Yu, F., & Talley, K. M. (2020). The Effects of Nursing Home Culture Change on Resident Quality of Life in U.S. Nursing Homes: An Integrative Review. Research in Gerontological Nursing. https://doi.org/10.3928/19404921-20200115-02

Haugan, G., Moksnes, U. K., & Løhre, A. (2016). Intrapersonal self-transcendence, meaning-in-life and nurse-patient interaction: powerful assets for quality of life in cognitively intact nursing-home patients. Scandinavian Journal of Caring Sciences, 30(4), 790–801. https://doi.org/10.1111/scs.12307

Olsen, C., Pedersen, I., Bergland, A., Enders-Slegers, M.-J., Jøranson, N., Calogiuri, G., & Ihlebæk, C. (2016). Differences in quality of life in home-dwelling persons and nursing home residents with dementia – a cross-sectional study. BMC Geriatrics, 16(1). https://doi.org/10.1186/s12877-016-0312-4

Sandgren, A., Arnoldsson, L., Lagerholm, A., & Bökberg, C. (2020). Quality of life among frail older persons (65+ years) in nursing homes: A cross‐sectional study. Nursing Open, 8(3), 1232–1242. https://doi.org/10.1002/nop2.739