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    SOCIAL INTERACTION IN NURSING HOMES 1

    Social Interaction In Nursing HomesMolly Graebner

    Professor Flom

    WRD 104

    5/22/2012

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    We all will grow old. It is an inevitable change that everyones life will come

    to eventually. What we decide to do about that change, and how it will effect us, is

    entirely up to us. The saying goes we are only as young as we feel, can be a positive

    way to look at this change, and pertains a lot to the concept of maintaining social

    awareness and cognitive thinking. One way we can keep feeling young, is to keep

    acting young by partaking in activities, which include social interactions and staying

    physically active. At a young age we are taught to make friends and try new things.

    Most kids will do anything to earn that time in which they can have a friend over, or

    be included in a play date. What makes the elderly so different from wanting these

    same things? Maintaining social interactions and including time in everyday for the

    mind to be tested will increase ones state of mind both physically and mentally. The

    importance of this among elders is not stressed enough. This has been an issue in

    nursing homes for over 30 years. The main concern is how to go about pursuing

    these social interactions. Fixing the standing conflictions of what exactly needs to be

    done to increase social interaction is necessary in order for progress to be made.

    However, it is my belief that increasing social interactions in a nursing home will

    allow for a healthier mental and physical state of a resident, and the importance on

    this cannot be stressed enough.

    In my junior and senior year of high school I worked at Stonecrest Nursing

    Home in Woodbury, MN as a dietary assistant. Although I worked specifically with

    food, I noticed many things about the patients and how they interacted with each

    other. Most would start out their day with breakfast, then go back to their rooms to

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    rest, followed by lunch, then break, and followed by dinner, and then some would

    partake in dancing after dinner. The schedule almost every day was exactly the

    same. The residents had reached a comfortable point in which not much work was

    exerted on their mind because everything had become a routine. This was important

    to maintain, to keep residents happy. After all, it is their home too. However, to see a

    positive change for the residents, a development of social interaction programs

    needs to be pursued. It was always interesting to see those residents who loved to

    talk and be a part of all activities, while others kept to themselves and seemingly

    had no interest in participating in anything offered. It was not the case for all

    residents, but most residents who wished not to participate would mentally become

    worse and worse, as months would go on. Hearing others, formulating sentences,

    engaging in conversations, and interest in anything were just a few of the factors

    that remained a problem as the quieter, more introverted, residents chose to not

    participate in engaging with other residents. It was under my detection that the

    cause of this might be due to the lack of social interaction between the residents and

    others, and could be fixed if they would interact with others in social activities.

    No matter who, the residents are communicating with, whether it is with a

    young or old person, it is important for them to keep their thought process at a high

    level, and engage themselves in activities. It is so easy to get caught up into being by

    yourself, and allowing those relationships you once had to slip away, however if

    youre health is at risk, there is more harm than previously shown. Not all of us are

    going to end up in a nursing home, however Researcher Colin J. Greaves (2006),

    author of article Effects of creative and social activity on the health and well-being

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    of socially isolated older people: outcomes from a multi-method observational

    study notes that Depression in particular is associated with social isolation and

    affects one in seven [among elders] over 65 (Greaves, 2006, p. 135). This essay

    comes from a study done in the UK, showing this to be a problem that expands over

    national boundaries. In order for the quality of life to be improved among people

    who may suffer from depression, Greaves makes the claim improved social

    functioning and social connectivity is associated with improved health and well-

    being.(p.135) At first, this issue started out as a matter of importance that social

    interaction can be stressed among elders, but through research Ive found that its

    not just bringing more social interaction into the residents lives, but what kind of

    interaction is most effective.

    A study by Kai-Jo Chiang et al (2009) entitled The effects of reminiscence

    therapy on psychological well-being, depression, and loneliness among the

    institutionalized age tests this theory by exploring the three types of therapy in

    which there could be possible advantageous tools in this distinction of what therapy

    works best. Among these include three types of therapy. One type of therapy is

    known as validation therapy, which tests the ability of a resident to understand

    communication and that they respond appropriately. Another type of therapy called

    cognitive behavioral therapy tests the theory that our thoughts cause our feelings,

    not anything thats out of our bodies. Reminiscence therapy, the therapy in which

    proves to be most effective on overall psychological well-being, uses the residents

    past as a base of knowledge they can use to improve their mental state of mind.

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    So, why a nursing home? Loved ones are often put into a nursing home as a

    reassurance that their health is being monitored and controlled. At the nursing

    home that I worked at, most residents were unmarried. Nursing homes can provide

    companionship and comfort knowing others are sharing the same experience at that

    stage of life. Ive known many residents who had actually grown up near, or with

    some of the other residents, which brings on a reminiscence therapy of its own. Of

    those that I knew who had those interactions with former friends, 3 out of the 4

    were social and seemingly happy. Nursing homes also have qualifications and a

    power of source, to control some of the actions that residents make. The trust of

    their families are in the caregivers to do what is best for the residents, so their

    authority is important to take into consideration as far as their personal autonomy

    is concerned. Within these experiments its important to keep in mind that the mood

    of an elder can be aggravated easily, and temperamental, so making abrupt changes

    to their schedule may not be easily accepted. In the midst of experimentation,

    Chiang et al (2009) reports, After 12 months, depression had significantly reduced

    and health-related quality of life had significantly increased. (p. 381) Since it is not

    easy to change the routine of their schedule, seeing results fast is simply not likely.

    Experiments have been done to test the relationship between social

    interactions and certain characteristics in residents such as their psychological

    cognitive ability, mental health, and level of happiness. To judge the effect of the

    tests, different scales are used. Kai-Jo Chiang in his reminiscence therapy

    experiment evaluates the patients on different depression scales, such as Geriatric

    Depression Scale, Cornell Scale for Depression in Dementia, and Hamilton Rating

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    Scale of Depression. Results support the theory that reminiscence therapy is

    positively impacting on the mind and depression level of elderly. Not only was

    reminiscence therapy proven to treat depression positively, but also it eased the

    feeling of loneliness among the elderly (Chiang, 2009, p. 382). It was also stated by

    Chiang (2009) reminiscence helped people to improve psychological well-being,

    (p. 381-382) only furthering support the claim that reminiscence therapy is a highly

    important and effective mechanism to the change of ones mental state.

    Another experiment, shown in The relationship between social interaction

    and characteristics of aggressive, cognitively impaired nursing home residents by

    Yu-Ling Chen (2000), uses a different type of scale called Social Interaction Scale

    (SIS). In this experiment, residents were examined for the frequency in which they

    would interact with others. Instead of being pushed, they were assessed for a

    minimum of six months based on how often they would interact with anyone else.

    This type of experimentation was not as effective as the work from Kai-Jo Chiang et

    al. work because the analysis of Chen et al. told what was found in an average

    elderly when assessed for how much social interaction they participate in, rather

    than how it is effecting them when tested.

    Meanwhile Colin J. Greaves takes a different approach, by using mentors as

    the main focus of delivering the interactions and encouraging creative thinking.

    Greaves (2006) states interventions that promote active social contact, and

    encourage stimulating creative activity, with support and guidance from a mentor,

    seem to have potential for improving health outcomes in elderly, socially isolated

    people. (p.135) This approach is different from the others, and is close to

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    unreliable, because of its lack of scale. The results purely come from assessment of a

    mentor, not a scientific scale. As mentioned before, moods of elderly can be easily

    influenced and agitated, so this assessment isnt going to be a definite result.

    These experiments are done in attempt to create a sustainable training to

    keep in a nursing home setting, so that the health of patients can only be improved.

    However, one problem has leaded this improvement to encounter a downfall, and

    that is money. Research done to explore the opportunities the caregivers can take

    part in was found in the article by Deborah E. Altus (2007) Finding a practical

    method to increase engagement of residents on a dementia care unit. In this article,

    instead of looking at the patients reaction to training, the caregivers were closely

    looked at in response to what they can be doing in order to raise engagement and

    participation. Although this research was successful in teaching the staff, the

    facility did not maintain the use of the training after the study was complete...given

    that staff training is expensive and time-consuming to maintain on a continuing

    basis (Altus, 245). This is going to be a factor among many issues if the only

    solution is to set up a training program. This, of course, depends on the size of a

    nursing home, and how many staff members they have.

    For a more efficient and reliable solution, there have been other ways to

    improve the health of these residents by increasing social interaction. Now that the

    research is done to prove social interaction can be effective in increasing

    psychological well-being, the question is what to do about it. An issue that these

    experiments raised was that appropriate and qualified nursing home cares for social

    interaction programs tend to be expensive, and hard to maintain. However, I saw

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    this to be an issue of prioritizing. How can you put a cost on youre loved ones

    health? I can understand where one would draw the line out of non-affordability;

    however there are programs out there that will increase revenue instead of making

    these painful costs bring their health down. These costs, especially, should be

    something to overlook because of the high number of continuing residential

    population in nursing homes.

    A study by Elizabeth M. Rash (2007) in Social Support in Elderly Nursing

    Home Populations: Manifestations and Influences, tests the social support and the

    influencing factors (p. 375) that social interaction can bring in a nursing home

    takes a closer look at the number of Americans this issue could be affecting. Rash

    (2007) concludes Since an estimated 1,465,000 people over the age of 65 occupied

    nursing homes on any given day in 1997 (Gabrel, 2000), a large number of this aging

    population will undoubtedly require some type of long-term care. (p. 276) Whilst

    the high number of residents supports the fact that this is a highly influential issue,

    it also proves that there is a lot of care that needs to go into this. A lack of time in the

    day also has shown to be an issue. There are routines and checklists that the

    caregivers need to follow that have already been established as their roles in a

    nursing home, so adding onto these activities will affect their timing. Additional

    caregivers would need to be hired in order to give attention to all the patients in a

    nursing home if this added work was included.

    One solution to this issue is the involvement of daycares in a nursing home.

    In Plymouth, WI there is a program called Intergenerational Center that integrates

    all generations in one community. This brings an idea of including a daycare in a

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    Nursing Home. Not only would revenue be increased because of the inclusion of the

    daycare income, but also patients would be able to interact with a younger

    generation, which could trigger those memories as part of reminiscence therapy,

    found in the experiment by Chiang et al (2009).

    However, I believe it does not have to be that extract of an idea in order for

    progress to be made. In Greaves research, a method called Upstream was used. This

    took patients and included them in creative-based activities, and one-on-one

    interviews about their past and how they felt after the activities. It was concluded

    from this research that The sense of increased optimism, self-worth and

    willingness to engage in life evident in the data suggests that the intervention was

    particularly effective in ameliorating depressed mood and loneliness, (Greaves,

    2006, p.137) which is the goal of this research. These experiments do show, though,

    within these experiments, that it is the caregiver, or mentor, that tends to have the

    most control over the patients progress, giving attention to the importance of the

    training and informing mentors of the findings.

    Psychological well-being is a characteristic that motivates every person,

    every day. Our happiness is what propels us to make certain decisions, and act the

    way we do. When this is jeopardized, it is in our will to get that back. And when we

    dont have control over our happiness, if we were cognitively impaired to the point

    in which making decisions is in the hands of someone else, it is important they know

    what they are doing. Loved ones are put into nursing homes to get the care they

    deserve-whether or not they can make their own choices; it is everyones will to be

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    happy. It is not a simple process, judging on these experiments done, there are a lot

    of different tactics that take a long period of time to actually be effective. However,

    at the cost of future happiness, and a pure, reliable program to aid in a healthier

    resident, physically and mentally, social interaction will be completely important in

    making that a priority.

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    Bibliography

    Altus, D. E., Engelman, K. K. and R. Mark Mathews (2002). Finding a practical method

    to increase engagement of residents on a dementia care unit.AmericanJournal of Alzheimers Disease Other Dementias. 17. doi:

    10.1177/153331750201700402.

    Colin J. Greaves, (2006) Effects of creative and social activity on the health and well-

    being of socially isolated older people: outcomes from a multi-method

    observational study. The Journal Of The Royal Society For The Promotion Of

    Health. 126. 134-142. doi: 10.1177/1466424006064303

    Chiang, K., Chu, H., Chang, H., Chung, M. Chen, C., Chiou, H. Chou, K. (2009). Theeffects of reminiscence therapy on psychological well-being, depression, and

    loneliness among the institutionalized aged. International Journal of Geriatric

    Psychiatry. doi: 10.1002/gps.2350.

    Chen, Y., Ryden, M., Feldt, K. Savik, K. (2000). The relationship between social

    interaction and characteristics of aggressive, cognitively impaired nursing

    home residents.American Journal of Alzheimers Disease and Other Dementias.

    15. 10-17. doi: 10.1177/153331750001500108

    Gabrel, C. S. (2000). Characteristics of elderly nursing home current residents and

    discharges: Data from the 1997 National Nursing Home Survey. Advance

    Data, 312, 1-16.

    Rash, E. (2007) Social support in elderly nursing home populations: manifestations

    and influences. The Qualitative Report. 12. 375-396.