Integrating social support into interventions among the elderly in nursing homes: a scoping review

Abstract

Objectives

This study aimed to understand the evidence related to integration of social support into interventions, to identify literature gaps related to social support interventions, and to clarify dimensions of supportive functions, outcomes, and providers among the elderly in nursing homes.

Design

This scoping review followed the approach by Arksey and O’Malley. The Mixed Methods Appraisal Tool V.2018 was used for quality assessment of the studies.

Data sources

Searches were conducted of the PubMed, ScienceDirect, Public Library of Science, SocioHub, Wiley Online Library and PsycINFO databases for publications from 2010 to 2021.

Eligibility criteria for selecting studies

We searched for primary studies and heterogeneous study designs published in English. Eligible studies took place in nursing and care homes and had study populations of elderly adults (older adults, geriatrics, ageing, seniors, older people and those aged 60 years and older).

Data extraction and synthesis

A data extraction form based on Joanna Briggs Institute’s recommendations for scoping reviews was used. Two reviewers independently extracted data and performed quality assessment of the studies. Then, extracted data and quality assessment reports were discussed by all authors.

Results

Thirty-one eligible studies were included in this review. 54.8% of the studies provided interventions for cognitively impaired residents. The top-three outcomes were neuropsychiatric symptoms, physical function and quality of life, respectively. The interventions were performed by nursing home staff (83.9%), other persons with specific qualifications (58.1%) and health volunteers (6.5%). Most studies (90.3%) depicted the integration of emotional and instrumental supportive functions into interventions.

Conclusion

The appropriate dimensions of supportive function, mainly emotional and instrumental support, are important to integrate into the social care of elderly people living in nursing homes.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• A well-defined a priori review protocol guided the execution of the study.

• The quality of each study was assessed.

• Specific results were identified via a standard data extraction form.

• The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews was used for reporting the results.

• The review was limited to primary research publications in English.

Introduction

Elderly people cared for in nursing homes require high budgets for treatments and care; they also need specific help and social care from formal caregivers for their personal strength and ability to maintain their daily activities and quality of life (QOL).^1–3 The WHO stated on the strategic objectives for providing long-term care that systems are needed in all countries to meet the needs of older people and to benefit beyond enabling care-dependent older people to do what they value and to live with dignity.⁴ A nursing home refers to a residential institutional setting that provides long-term care with 24-hour functional support for people who need assistance with several activities of daily living (ADLs) and instrumental ADLs.^{5 6}

Generally, nursing homes provide help for the elderly who require care, which is hard to provide by family members, helpers and specialists in home settings.⁷ The reasons of admission to nursing homes include chronic diseases leading to limitations in ADLs, mobility impairment, cognitive disturbance and living alone.^{8 9}

Living in nursing homes may have negative consequences for the elderly.¹⁰ Particularly, psychosocial impacts of the coronavirus pandemic on social isolation have presently been a worldwide concern. Seriously harmful problems especially for residents with cognitive impairment include depression, loneliness and worsening dementia.¹¹ Particularly, recent social isolation due to the pandemic together with poor social support are risk factors for suicide in older people.⁵ Age-related loss of multiple physical and psychological functions along with the transition to long-term care can be stressful life events that may decrease their QOL.¹²

Social services have been enacted in policies to increase healthy life expectancy thereby improving the QOL and other health outcomes. These services have been proven to be effective.^{1 13 14} Security based on public healthcare systems, an individual financial literacy and an effective supportive intervention from healthcare providers are important determinants influencing QOL among the elderly.¹⁵ However, the services may not cover or not match with the individual’s needs because of the differences between the residents’ and staff’s perspectives.^16–19 Providing a decent care for the elderly living in nursing homes depends on not only the intervention design itself, but also on individual providers. Moreover, provider shortage is a typical problem worldwide. Thus, an increase in the number of professional caregivers has been issued as one of the necessary strategies in public health sectors.^20–22

Social support refers to relationships among people who provide not only material help and emotional assurance, but also the sense of belonging to one to make them feel that they are still part of a community of people.²³ Based on theories and previous studies, social support has been confirmed as one of the important determinants which affect individuals’ health through its influence as a stress buffer and its main effects on emotion, cognition and behaviour. Hence, both physical and psychological health outcomes improved especially during the COVID-19 pandemic.^24–29 Besides, the individuals who obtained higher levels of social support have more positive health outcomes related to health status, role function and behaviours, psychosocial adjustment, adjustment to life, coping behaviour, health belief, health promotion behaviour, QOL, well-being and self-actualisation.³⁰

On the other hand, social support could also have a negative impact as a significant source of stress as feelings of indebtedness or guilt can occur.^{27 31} It is noteworthy that specific dimensions of supportive function referring to both quantitative and qualitative aspects depict beneficial roles on health being a personal resource in various stressful life events.³¹ Veiel pointed out that the types of available support should be included in a social support assessment.³² In addition, Wills and Shinar depicted the dimensions of available support or functional support relating to social support intervention in terms of (1) emotional support, (2) instrumental support, (3) informational support, (4) companionship support and (5) validation, which provide specific theoretically expected benefits for coping efforts.³³

In the literature, a trend towards a positive effect of social support and social interventions on social and health-related outcomes among older people in nursing homes has been receiving attention lately.³⁴ Even though there were two review articles regarding social support and interventions in terms of social interaction³⁵ and social relation,³⁴ none of these studies clearly reported on the dimensions of supportive function/the type of social support nor the supportive providers. Besides, there were no completed or ongoing studies identified on integrating social support into interventions.

Theoretically, involvement in a personally meaningful activity is a basic human drive that is essential to maintain good health, regardless of age or impairment.³⁶ Social support activities are important for the elderly as coping resources by regulating thoughts, feelings and behaviour to promote health, fostering an individual’s sense of meaning in life and facilitating health promoting behaviours.^{24 37} However, it is not easy to encourage the elderly who have psychological and physical health problems to identify meaningful activities and to participate in these.³⁸ Consequently, evidence-based planning and good preparation of healthcare providers should be worthy strategies to boost effective care covering the needs of the elderly living in nursing homes.

A scoping review is a type of review that can be used to map the key concepts that underpin a field of research, as well as to clarify working definitions and/or the conceptual boundaries of a topic.^{39 40} The aims of this scoping review were (1) to understand situations of providing social support into interventions among the elderly in nursing homes, (2) to identify literature gaps in social support interventions, and (3) to clarify the dimensions of supportive functions, outcomes and providers of supportive interventions among the elderly in nursing homes. The findings from this review can be used to guide nursing home policies and to develop proper social interventions for the elderly including guiding us to design further studies.

Methods

Details of our methodology regarding the study protocol were published previously.⁴¹ Briefly, the current study was performed following the five stages of scoping review described by Arksey and O’Malley. These include (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarising and reporting the results.³⁹ The Mixed Methods Appraisal Tool (MMAT) V.2018 was used for the quality assessment of the selected studies.^{42 43}

Stage 1: identifying the research question

Scoping review questions include the main question ‘What have been studied so far about providing social support into interventions among the elderly in nursing homes?’ and subquestions (1) ‘What are the interventions and outcomes related to social support?’, (2) ‘Who are the intervention providers in nursing homes?’ and (3) ‘Which dimensions of supportive functions were integrated into interventions?’.

Stage 2: identifying relevant studies

Eligibility criteria

The population, concept, context and types of sources recommended by the Joanna Briggs Institute (JBI) were used to set the inclusion and exclusion criteria for the study selection by considering titles and abstracts of articles.⁴⁰ We included the English records of the elderly population (older adults, geriatrics, ageing, seniors, older people and those aged 60 years and older) and excluded others that care receivers were infants, children, adolescents, mothers, parents, women, men and homeless persons. Studies had to take place in nursing or care homes. Settings including communities, primary care home(s), homes, day care centre(s), hospital(s), clinics, special clinics, emergency departments and outpatient departments were excluded. We considered primary studies and heterogeneous study designs including all types of qualitative, quantitative and mixed-methods studies. The review excluded all types of reviews, protocols, book chapters, opinion papers, editorial letters, guidelines and annual conferences.

Search strategy

The search strategies, including all identified keywords and index terms, were adapted for each included database and/or information source. Terms derived from research questions were identified as the following six search components: (1) social support, (2) intervention, activity or programme, (3) outcome, (4) provider or staff, (5) elderly, and (6) nursing home or care home. The four main searches using search terms from search components were added in the search fields and combined different search terms with ‘AND’ mainly in advanced search of all databases from search components as follows:

• Search 1: social support AND elderly AND (nursing home OR care home)

• Search 2: social support AND (intervention OR activity OR program) AND elderly AND (nursing home OR care home)

• Search 3: social support AND (intervention OR activity OR program) AND outcome AND elderly AND (nursing home OR care home)

• Search 4: social support AND (intervention OR activity OR program) AND (provider and staff) AND elderly AND (nursing home OR care home)

Giving consideration to quick changes with the acquisition of new knowledge in healthcare and social science fields, we attempted to provide an up-to-date report. To include the latest information, we excluded publications from before the year 2010. Filters related to publication in English from 1 January 2010 to 31 March 2021 were designed in the study protocol. However, filtering with specific date and month was not possible in searching for all databases. Consequently, filters related to (1) the inclusion criteria, (2) publication in English from 2010 to 2021 and (3) full-text availability were applied. We conducted the searches from 8 June 2021 through 1 January 2022.

Taking into account the relevance of thousands of citations retrieved from bibliographical database searches, we limited the search to words contained in the titles and/or abstracts.⁴⁴ The main searches were conducted from available information in social science and medical databases of the university library including PubMed, ScienceDirect, Public Library of Science, SocioHub, Wiley Online Library and PsycINFO databases.⁴⁵ In addition, the library service of our hospital was also used. As an example of the searches, the electronic search of PubMed is reported in table 1. The complete report of the search strategy is presented in online supplemental file 1.

Table 1.

Electronic search of PubMed (total=818 results)

Number of searches	Search	Results	Date of the most recent search
Search 1 (component 1+component 5+component 6)	Search: ((social support[Title/Abstract]) AND (elderly[Title/Abstract])) AND (nursing home[Title/Abstract] OR care home[Title/Abstract]) Filters: Abstract, Full text, Journal Article, in the last 10 years, English, Aged: 65+ years	10	Fri, 16 Jul 2021 at 15:33
Search 2 (component 1+component 2+component 5+component 6)	Search: (social support[Title/Abstract]) AND (intervention[Title/Abstract] OR activity[Title/Abstract] OR program[Title/Abstract])) AND (elderly[Title/Abstract])) AND (nursing home[Title/Abstract] OR care home[Title/Abstract]) Filters: Abstract, Full text, Journal Article, in the last 10 years, English, Aged: 65+ years	4	Fri, 16 Jul 2021 at 15:22
Search 3 (component 1+component 2+component 3+component 5+component 6)	Search: (social support)[Title/Abstract] AND (intervention[Title/Abstract] OR activity[Title/Abstract] OR program))[Title/Abstract] AND (outcome))[Title/Abstract] AND (elderly))[Title/Abstract] AND (nursing home[Title/Abstract] OR care home)[Title/Abstract] Filters: Full text, Journal Article, in the last 10 years, English, Aged: 65+ years	557	Fri, 16 Jul 2021 at 14:38
Search 4 (component 1+component 2+component 4+component 5+component 6)	Search: (social support)[Title/Abstract] AND (intervention[Title/Abstract] OR activity[Title/Abstract] OR program)[Title/Abstract] AND (providers[Title/Abstract] OR staff))[Title/Abstract] AND (elderly)[Title/Abstract] AND (nursing home[Title/Abstract] OR care home)[Title/Abstract] Filters: Abstract, Full text, Journal Article, in the last 10 years, English, Aged: 65+ years	247	Fri, 16 Jul 2021 at 15:08

Stage 3: study selection

Of all 1719 identified results, 1689 results came through databases, 24 results from hand search and 6 results from reference lists. After removing 752 duplicates and excluding 838 articles in the ‘screening in title and abstract’ step, 129 articles were assessed by full-text review for eligibility. Finally, 31 studies were included in this review. The search results are shown as flow diagram using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) (see figure 1).^{46 47} PRISMA-ScR has been recommended by JBI as a part of methodological guidance for the conduct of scoping reviews.^{48 49}

Figure 1.

PRISMA flow diagram for study selection process.⁴⁷ PLoS, Public Library of Science; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analysis.

Stage 4: charting the data

The MMAT V.2018 was used to assess the quality of the studies.⁴³ This instrument has proven useful in other mixed-methods systematic reviews encompassing a transparent and comparable approach to appraise studies with different designs.^{50 51} Study designs included qualitative research (n=1), randomised controlled trials (n=15), non-randomised studies (n=12) and mixed-methods studies (n=3).

A standardised data extraction form was used.⁴¹ Primarily, two reviewers independently extracted data of the studies. Then, extracted data reports were discussed by all authors. In this process, there were some items that we could not get some information as we had designed in the study protocol. These were related to the age groups and the categories of nursing home residents. Consequently, age was reported as the mean age of the elderly, and the residents in interventions were categorised into (1) residents (non-specified health status residents), (2) residents with cognitive impairment, (3) residents without cognitive impairment and (4) residents with other specific health problems in this study.

Stage 5: collating, summarising and reporting the results

The results are reported below, in accordance with the PRISMA-ScR reporting guidance.

Patient and public involvement

None.

Results

Overall, 31 studies were selected for this review (table 2). Quality assessment of the studies was performed, and the overall scores were reported (online supplemental file 2). We found that 18 studies (58.1%) met 100% of the quality criteria of the MMAT-2018 overall score, followed by 8 (25.8%), 3 (9.8%) and 2 (6.5%) studies with 80%, 60% and 40% of the quality criteria, respectively.

Table 2.

Overview of selected studies (N=31)

Author, year, category of study designs based on MMAT-2018	Country	Title
Adam et al (2016)65 Non-RCT	Malaysia	Effectiveness of a combined dance and relaxation intervention on reducing anxiety and depression and improving quality of life among the cognitively impaired elderly
Arrieta et al (2018)53 RCT	Spain	A multicomponent exercise program improves physical function in long-term nursing home residents: a randomized controlled trial.
Ballard et al (2018)54 RCT	UK	Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: a cluster-randomised controlled trial
Chiu et al (2018)72 Non-RCT	Taiwan	Effects of resistance training on body composition and functional capacity among sarcopenic obese residents in long-term care facilities: a preliminary study
Cohen-Mansfield et al (2010)73 Non-RCT	USA	The value of social attributes of stimuli for promoting engagement in persons with dementia
Giné-Garriga et al (2020)74 RCT	Spain and Sweden	A pilot randomised clinical trial of a novel approach to reduce sedentary behaviour in care home residents: feasibility and preliminary effects of the GET READY Study
Graessel et al (2011)55 RCT	Germany	Non-pharmacological, multicomponent group therapy in patients with degenerative dementia: a 12-month randomized, controlled trial
Guzmán et al (2016)64 MM	UK	Psychomotor Dance Therapy Intervention (DANCIN) for people with dementia in care
Guzmán-García et al (2013)69 QUAL	UK	Introducing a Latin ballroom dance class to people with dementia living in care homes, benefits and concerns: a pilot study
Hanson et al (2017)52 RCT	USA	Effect of the goals of care intervention for advanced dementia: a randomized clinical trial
Haslam et al (2014)70 Non-RCT	UK	We can work it out: group decision-making builds social identity and enhances the cognitive performance of care residents
Henskens et al (2017)56 Non-RCT	The Netherlands	Implementation and effects of Movement-oriented Restorative Care in a nursing home - a quasi-experimental study
Husebø et al (2019)57 RCT	Norway	The effect of a multicomponent intervention on quality of life in residents of nursing homes: a randomized controlled trial (COSMOS)
Jansen et al (2018)58 Non-RCT	Germany	Pushing the boundaries: a physical activity intervention extends sensor-assessed life-space in nursing home residents
Jøranson et al (2015)59 RCT	Norway	Effects on symptoms of agitation and depression in persons with dementia participating in Robot-Assisted Activity: a cluster-randomized controlled trial
Lai et al (2018)75 RCT	Hong Kong	Effects of horticulture on frail and prefrail nursing home residents: a randomized controlled trial
Lee et al (2010)76 Non-RCT	Hong Kong	The psychosocial effect of Tai Chi on nursing home residents
Magee et al (2017)77 MM	Ireland	Feasibility of the Namaste Care Programme to enhance care for those with advanced dementia
Olsen et al (2016)78 RCT	Norway	Effect of animal-assisted interventions on depression, agitation and quality of life in nursing home residents suffering from cognitive impairment or dementia: a cluster randomized controlled trial
Pereira et al (2018)66 Non-RCT	Portugal	Effects of a 10-week multimodal exercise program on physical and cognitive function of nursing home residents: a psychomotor intervention pilot study
Ray and Mittelman (2015)79 Non-RCT	USA	Music therapy: a nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia
Raynor et al (2020)67 MM	Australia	It’s not just physical: exercise physiologist-led exercise program promotes functional and psychosocial health outcomes in aged care
Richter et al (2019)60 RCT	Germany	Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial
De Rooij et al (2012)61 Non-RCT	The Netherlands and Belgium	Quality of life of residents with dementia in traditional vs small-scale long-term care settings: a quasi-experimental study
Slaughter et al (2015)62 Non-RCT	Canada	Mobility of vulnerable elders study: effect of the sit-to-stand activity on mobility, function, and quality of life
Telenius et al (2015)68 RCT	Norway	Effect of a high-intensity exercise program on physical function and mental health in nursing home residents with dementia: an assessor blinded randomized controlled trial
Tsai et al (2010)81 Non-RCT	Taiwan	Videoconference program enhances social support, loneliness, and depressive status of elderly nursing home residents
Tse et al (2020)71 RCT	Hong Kong	An exploration of the effectiveness of a peer-led pain management program (PAP) for nursing home residents with chronic pain and an evaluation of their experiences: a pilot randomized controlled trial
Van de Ven et al (2013)63 RCT	The Netherlands	Effects of dementia-care mapping on residents and staff of care homes: a pragmatic cluster-randomised controlled trial
Van der Ploeg et al (2013)82 RCT	Australia	A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with dementia
Werner et al (2015)80 RCT	Germany	Effectiveness of group music therapy vs recreational group singing for depressive symptoms of elderly nursing home residents: pragmatic trial

MM, mixed-methods; MMAT, Mixed Methods Appraisal Tool; QUAL, qualitative; RCT, randomised controlled trial.

More than half of the studies (61.3%) were performed in Europe, followed by Asia (19.4%), North America (12.9%) and Australia (6.5%). The included resident groups in the study had a mean age of 70.9–89.1 years; the number of participants in the studies had a wide range, from 9 to 1153 residents.

The findings related to interventions are reported (online supplemental file 3). Overall, 54.8% of the studies provided interventions for the cognitively impaired, 6.5% for residents without dementia, 3.2% for residents with depression, 3.2% for residents with chronic pain, 3.2% for residents with schizophrenia or bipolar disorder, and 3.2% for residents with sarcopenic obesity with sedentary lifestyles. A total of 22.6% of the studies did not specify the residents’ health status.

The dimensions of supportive function were identified. The results showed that 90.3% of the studies integrated emotional and instrumental supportive functions into interventions, while information support and validation were identified in 58.1% and 61.3%. Among other outcomes, the top three in this review were neuropsychiatric symptoms (NPSs) (87.1%), physical function (61.3%) and QOL (45.2%).

The interventions were provided by nursing home staff (83.9%), health volunteers (6.5%) and other professionals with specific qualifications (58.1%). The group ‘nursing home staff’ included social workers,⁵² nurses,^52–63 physicians,52 54 57 60 64 physiotherapists,^{52 65–68} healthcare aides (HCAs)⁶² and non-specified providers.^{69 70} There were two studies in which the interventions were provided by health volunteers.^{56 71} However, there were studies that required specific qualifications or training of providers including physical trainers,⁵³ WHELD champions,⁵⁴ professional health trainers,⁷² trained research assistants,⁷³ GET READY champions,⁷⁴ therapists/aides/study coordinators,⁵⁵ proprietors (retired nurses)/housekeeping or kitchen staff,⁶⁴ nutritionists,⁵² family caregivers,⁵⁶ graduated sports scientists for group training and student assistants (either sports science or psychology) for one-on-one training,⁵⁸ registered horticultural therapists,⁷⁵ Tai Chi instructors,⁷⁶ activity therapists,⁷⁷ qualified dog handlers,⁷⁸ music therapists,^{79 80} trained research assistants⁸¹ and facilitators (psychologists and higher-degree psychology students).⁸²

Discussion

We found only one study in which the authors mentioned a social support concept as a theoretical framework for their study.⁷¹ However, we found that means of supportive function dimensions based on Wills and Shinar’s concept³³ were integrated in part of the interventions through designs and modes of delivery. Furthermore, we found that a social support concept is often related to other concepts such as social support network,⁷⁶ social network,⁷⁵ social engagement,61 67 70 73 75 social interactions^{69 74} and social identity.⁷⁰ This confirms previous studies which found that social network, social connection, social support and social engagement were often related to one another under the different contexts and cultures promoting social outcomes and QOL.^{34 83}

In the 10-year period of this review, we noticed that not only emotional and instrumental support have been mentioned as key supportive functions, but informational support such as information technology (IT) has also shown to have an important role in caring for the elderly in nursing homes. It can be a strategy for promoting family relationships and support both the elderly and their family in the mental health domain.^{59 81} We also found interventions using technology to assess life-space⁵⁸ and to monitor sedentary behaviour.⁷⁴ In addition, IT was used as a social stimulus such as a life-like baby doll, a robotic animal and a respite video for promoting engagement in persons with dementia.⁷³ IT has been developed and integrated into nursing care in many organisations worldwide.^{84 85} It has played an important role and was involved in interventions of daily activities during the COVID-19 pandemic.^86–88 Even through IT-based measures such as video calls were beneficial for individuals by staying connected with their loved ones, there were also barriers including staff turnover, risk averseness, the specific study design, lack of family commitment and staff attitudes regarding technology.⁸⁹

Dimensions of supportive function

For the elderly living in care environments, structural social support is measured by the size of the individual’s social network and frequency of contact within this network, whereas functional social support is an individual perception of the quality or value of this support.⁸⁹ Thus, a lack of structural and functional social support induces personal social isolation.⁹⁰ Bonding between residents and providers can occur and increase through their interpersonal relationships.⁹¹ As a job responsibility, every provider in nursing homes should have the possibility to provide social support in various types of supportive functions matching with the individual resident’s needs or problems. In this current review, emotional and instrumental support functions provided by nursing home staff were depicted as the most dominant dimension integrated into interventions (n=28, 90.3%) followed by companionship support (n=26, 83.9%). It is noted that specific dimensions may play important roles in a particular group of elderly people and their family.⁹² Therefore, healthcare providers should consider all dimensions of supportive functions and their priority to design interventions that are appropriate for each specific target population may maximise quality of services in nursing homes.

Outcomes

The literature indicates that a higher level of perceived institutional peer support was significantly correlated with a higher level of physical function and mental health status.⁹³ Our findings show that NPSs were the most often used intervention outcomes, followed by physical function and QOL, respectively. Commonly, NPSs include depression, irritability, anxiety, agitation, apathy/indifference, delusions and hallucinations.⁹⁴ Social support was integrated into interventions especially for those elderly persons with cognitive impairment who often have psychological problems accompanying their physical health problems. The literature confirmed the value of social support as having direct and moderate effects in the elderly who had psychological problems such as loneliness,^{95 96} depression,^{93 97–99} suicidal idea¹⁰⁰ and poor sleep quality.¹⁰¹ Social support has been reported as an influencing factor to promote positive outcomes such as social integration,⁸³ physical function,⁹³ resilience,⁹⁶ self-esteem,⁹⁹ social contact,¹⁰² good adaptation¹⁰³ and adjustment to nursing homes.¹⁰⁴

Providers

The nursing staff have a significant influence on the residents’ health outcomes.¹⁰⁵ They play an important role in supporting the residents’ autonomy in different ways.¹⁰⁶ In this study, we found 12 studies (38.7%) in which the interventions were provided by the nursing staff.^52–63 Nursing professionals provide treatment, support and care services; they assume responsibility for the planning and management of care of persons including the supervision of other healthcare workers, thereby working autonomously or in teams with doctors and others.¹⁰⁷ Nurses and their staff often take roles to restore and maintain mobility among the instituted elderly. Nurses have been mentioned in the literature to facilitate caregivers’ emotional, tangible and informational support.¹⁰⁸ Evidently, social support is an important factor for improving positive patient outcomes. However, less research has addressed the roles of nursing professionals in providing social support to patients and families.¹⁰⁹ Furthermore, physicians have been depicted as intervention providers in five studies (16.1%) of this review.52 54 57 60 64 Specialist doctors and/or nurses have been mentioned as the first-line medical professionals to improve key health outcomes.¹⁸

The results showed a high percentage of delivery modes of interventions as exercise and/or physical activities, which normally should be provided by physical therapists. We found only five studies (16.1%) in which the interventions were provided by a physiotherapist.^{52 65–68} Physiotherapists have been mentioned as supportive intervention providers. The reasons of admission to nursing homes generally include limitations of extensive ADLs, mobility impairment, living alone and cognitive disturbance due to chronic illnesses.^{8 9} Physiotherapists respond mainly to physical limitations. In the period of the coronavirus pandemic, they held the vital roles for early rehabilitation to reduce the severity of symptoms and to decrease the treatment cost of COVID-19.¹¹⁰ However, staff shortage has been found to be the long-standing barrier to appropriate social care for the elderly in nursing homes.^{111 112}

Moreover, social workers have been considered as key providers decreasing physiological and psychological health problems in nursing homes.⁸³ Importantly, assisting staff such as certified nursing assistants, one of the frontline staff members, have supported job responsibilities caring for the residents on their basic needs and/or simplified activities in nursing homes.¹¹³ Interestingly, we found only one study (3.2%) mentioning social workers and/or HCAs as intervention providers in this review.

Presently, the coronavirus pandemic did not only impact the national healthcare budget but also reinforce the severity of staff and personal protective equipment shortages in nursing homes.^113–115 Obtaining support from health volunteers to care for the residents is another helpful option to provide social care for the elderly. In this study, there were two studies (6.5%) that mentioned health volunteers as intervention providers.^{56 71}

Implications

This review study depicted that the effectiveness of interventions for the instituted elderly depended on the local culture of the countries and continents. Generally, various physical activities have been used as routine interventions in nursing homes, that is, Tai Chi,⁷⁶ multimodal exercise programme⁶⁶ and sit-to-stand activity.⁶²

It is noted that there were 28 effective interventions for specific health status groups. In addition, there were three studies in which the effects of the interventions were not significant, but which also had some benefits. Thus, the verified interventions may make it easy and convenient to specifically apply in the care for the various groups of residents. For instance, the interventions for the residents with cognitive impairment included Well-being and Health for People with Dementia (WHELD),⁵⁴ motor stimulation, practice in activity of daily living, and cognitive stimulation (MAKS),⁵⁵ Psychomotor DANCe Therapy INtervention (DANCIN),⁶⁴ Danzo’n Psychomotor Intervention (DPI),⁶⁹ goal of care (GOC),⁵² Movement-oriented Restorative Care (MRC),⁵⁶ robot-assisted group activities,⁵⁹ Namaste Care,⁷⁷ animal-assisted activities (AAA),⁷⁸ High Intensity Functional Exercises (HIFE),⁶⁸ Montessori-based activities,⁸² small-scale living⁶¹ and Dementia-Care Mapping (DCM).⁶³ The intervention for the residents with pain was the Peer-Led Pain Management Program (PAP)⁷¹ and for the residents with depression was the group music therapy.⁸⁰ In addition, if there are enough skilled staff, the EPCentCare was recommended to improve the positive outcomes in the residents with schizophrenia or bipolar disorder.⁶⁰ The intervention design with integrated social support in a multicomponent activity possibly benefits residents, especially the individuals with severe cognitive impairment and/or in palliative care. This concerns QOL and longer lifespans for the residents in nursing homes.

Study limitations

Searching for only English articles and only for primary research may comprise study limitations. Concerning the review of multiple cultures, we found some difficulty in identifying studies in the context of nursing homes, making clear definition of the study settings with explicit criteria necessary for selecting studies.

Conclusion

Social support is an important influencing factor of individuals’ well-being. The appropriate dimensions of supportive function, mainly emotional and instrumental support, are important to integrate into the social care for the elderly living in nursing homes. This is especially crucial in a post-coronavirus pandemic. Additionally, staff empowerment and using the available verified interventions in specific target groups may promote staff commitment of giving the best social care for the residents. In a different cultural context, development of proper social interventions and further studies of social interaction between providers and receiving residents are recommended.

Data availability statement

No data are available.

Ethics statements

Patient consent for publication

Not required.

Ethics approval

This study did not include humans or animals as participants. Data were sourced from published literature; thus, ethics approval was not required.