Abstract
Introduction and purpose
Residents in long-term care exhibit diminishing senses (hearing, sight, taste, smell or touch). The purpose of this study was to examine the available literature on the impact of sensory interventions on the quality of life of residents living in long-term care settings.
Methods
We conducted a mixed-methods scoping review using Arksey and O’Malley’s framework. Seven databases (Medline (Ovid), PubMed (non-Medline-Ovid), CINAHL (EBSCO), Embase (Ovid), Ageline, PsycINFO (Ovid), Cochrane Central Register of Controlled Trials until 1 December 2020) were searched. Two reviewers independently screened the studies for sensory interventions using a two-step process. Eligible studies underwent data extraction and results were synthesised descriptively.
Results
We screened 5551 titles and abstracts. A total of 52 articles met our inclusion criteria. Some interventions involved only one sense: hearing (n=3), sight (n=12), smell (n=4) and touch (n=15). Other interventions involved multiple senses (n=18). We grouped the interventions into 16 categories (music programmes, environmental white noise, bright light interventions, visual stimulations, olfactory stimulations, massages, therapeutic touch, tactile stimulations, physical activity plus night-time programmes, pet therapies, various stimuli interventions, Snoezelen rooms, motor and multisensory based strategies, Namaste care, environmental modifications and expressive touch activities).
Conclusion
This preliminary review summarised some of the available sensory interventions that will help inform a series of future systematic reviews on each of the specific interventions. The evidence-based knowledge for sensory interventions will also inform a future audit programme for assessing the presence of sensory interventions in long-term care.
Keywords: general medicine (see internal medicine), health services administration & management, quality in health care, geriatric medicine
Strengths and limitations of this study.
We considered a wide range of sensory interventions published in the literature.
Only studies that specifically mentioned at least one of the five senses were included.
The screening and data extraction were performed in duplicate.
We could have missed evidence of possible interventions because the authors did not specifically mention one of the senses.
Introduction
Our population is ageing. According to new data from the UN, by 2050, one in six people worldwide will be over age 65, up from 1 in 11 in 2020.1 In Europe and North America, by 2050, one in four people will be 65 or over, and the number of people 80 and older worldwide is projected to triple by 2050, from 143 million to 426 million.1
As people age, their senses (hearing, sight, taste, smell and touch) decline.2 3 Previous research has associated sensory loss with decreased quality of life in older adults.4–13 As the population gets older, many more people will be living in long-term care communities. These sensory impairments are not always considered in the design of these environments.
Many studies have investigated methods of modifying the physical environment to create a more enriching sensory environment for older adults living in long-term care settings. Such interventions have included: adequate lighting,14 appropriate environmental temperatures,15 removal of unpleasant noises,16 presence of pleasant sounds (music)17 and installation of multisensory environments including sensory gardens or Snoezelen rooms.18 Other studies have focused on sensory interventions such as: physical contact,19–22 animal therapy,23 aromatherapy and essential oils,24 25 and nutrition.26–32
Although, research on older adults and sensory decline exists, this is the first review that focuses on the relationship between sensory interventions and the quality of life of residents living in long-term care settings. To our knowledge, no reviews to date have critically analysed the impact of sensory interventions on the quality of life of older adults living in long-term care. This study aimed to examine the available literature on the impact of sensory interventions on the quality of life of residents living in long-term care settings. Specific objectives were: (1) to summarise the current knowledge of sensory interventions on the quality of life of residents living in long-term care and (2) to assess the impact of these sensory interventions on quality of life and/or individual concepts of quality of life of residents.
Methods
Research design and methodology
We followed the five-stage process by Arksey and O’Malley33 for conducting this scoping review: (1) identify a research question, (2) identify studies relevant to the research question, (3) review and select a subset of studies for inclusion in the final review, (4) chart the information and data for the selected studies and (5) collate, summarise, and present the results. We also adhered to the Preferred Reporting Items for Systematic Reviews, Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guideline.34 The PRISMA-ScR checklist is available in online supplemental table S1.
bmjopen-2020-042466supp001.pdf (1.5MB, pdf)
Patient and public involvement
No patients involved.
Deviations from the protocol
Originally, we had planned to conduct a mixed-methods systematic review and had published our methods in a protocol.35 However, given the broad nature of the topic and our findings, we decided to first conduct a scoping review that will then guide a future series of focused systematic reviews on each of the sensory interventions identified in this scoping review.
Identify a research question
Our research question for the scoping review was: What is known from the existing literature about the impact of sensory interventions on the quality of life of residents living in long-term care settings?
Identify studies relevant to the research question
The search strategy was devised in consultation with a specialist health sciences librarian (JS), and a second health sciences librarian peer reviewed the search strategies using the Peer Review for Electronic Search Strategies.36 The following databases were searched from inceptionto 1 December 2020: Medline (Ovid), PubMed (non Medline-Ovid), CINAHL (EBSCO), Embase (Ovid), Ageline, PsycINFO (Ovid) and the Cochrane Central Register of Controlled Trials. The search strategy used in the MEDLINE database is available in online supplemental table S2. No restrictions were applied to language, publication type or year.
bmjopen-2020-042466supp002.pdf (87.4KB, pdf)
Inclusion and exclusion criteria were applied to all studies, enabling a transparent and focused selection of articles of interest.
We included:
Studies with older adult residents living in long-term care settings. We adapted the definition of ‘older person’ depending on the settings where the studies were conducted. For example, the WHO’s definition for ‘older people’ in Africa is 60 years of age or older.37 Long-term care settings were defined as: ‘domestic-styled environment[s] that provides 24-hour functional support and care for persons who require assistance with activities of daily living and who often have complex health needs and increased vulnerability’.(38, P 183)
Studies focused on any of the five senses (sight, hearing, taste, touch and smell) implemented by an organisation. Interventions had to be implemented at the facility or unit level and had to include at a minimum one of the five senses. Examples of such interventions include but are not limited to auditory stimulation (used to enhance mood, promote relaxation and cognition), pet therapy (used to reduce agitation and provide social stimulation, particularly in older people with dementia) and modification of the physical layout of the environment (allowing residents to see and smell food as it is being prepared).
Studies focused on the following outcomes: health-related quality of life or any of the six individual components of quality of life (mental health, energy/fatigue, emotional well-being, bodily pain, social functioning and satisfaction). Health-related quality of life was defined as ‘a multidimensional concept that includes domains related to physical, mental, emotional and social functioning. It goes beyond direct measures of population health, life expectancy, and causes of death, and focuses on the impact health status has on quality of life’.(39, P1) The individual components of quality of life were based on the 36-Item Short Form Survey (V.1.0).40
Randomised and non-randomised studies, controlled before-and-after studies, retrospective or prospective cohort studies, mixed-methods studies and qualitative studies (that included an intervention).
We excluded:
Studies combining long-term care and non long-term care populations (eg, acute care, community-dwelling elders) where outcomes were not reported separately by population.
Review and select a subset of studies for inclusion in the final review:
All records were exported into Covidence (an online systematic review software)41 for removal of duplicates and reference management. We used a two-step process to screen the results of the literature search as follows: (1) title and abstract screening and (2) full-text screening. Screening was performed independently by reviewers (DC-Y, MD-V and MC). Another reviewer (CB) was consulted in the case of inclusion and exclusion conflicts.
Chart the information and data for the selected studies
Two reviewers (MD-V and DC-Y) independently extracted data from each study using a standardised data abstraction form. Data included: study characteristics (year of publication, authors, country), study objectives, study design, target population, sample size, description of the practice, outcome measures and study results. Authors of the studies were contacted to request missing or additional data where required and were given 30 days to respond.
Collate, summarise and present the results
The data extracted from the eligible studies were grouped by intervention type and analysed according to each of the senses (hearing, sight, taste, touch, smell). Studies that included more than one sense were aggregated and analysed separately. Due to the wide range of sensory interventions found in the included studies, the results are presented descriptively.
Results
Study selection
Results of the search strategy were documented within the PRISMA flow diagram (figure 1). We obtained 10 878 records from our searches. After removal of duplicates, 5551 records were screened for inclusion. Application of the inclusion criteria to titles and abstracts resulted in the exclusion of 5238 records. We retrieved 313 full-text articles; following application of inclusion criteria to full-text articles, we retained 52 studies18 20 22 24 25 42–90 (see table 1). Excluded full-text articles (n=261), and reasons for exclusion are found in online supplemental table S3.
Figure 1.
PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses. LTC, long-term care.
Table 1.
Characteristics of the included studies (n=52)
Reference | Study design | Country | Setting | Population | Intervention categories | Quality of life outcomes |
Studies involving hearing-related interventions | ||||||
Burgio (1996)42 | Non-controlled before-and-after study | England | 2 nursing homes | n=13, residents with severe cognitive impairment | Environmental “white noise” A specific environmental sound tape for use on the unit |
Emotional well-being (agitation) |
Goddaer (1994)43 | Non-controlled before-and-after study | Belgium | 2 nursing homes | n=29, dementia residents | Relaxing music during meals | Emotional well-being (agitation) |
Travers (2011)44 | Non-controlled before-and-after study | Australia | Community-dwelling persons and residents of residential care facilities | n=72, dementia residents | Radio/music programme Listening to a daily radio programme |
Quality of Life – Alzheimer’s disease Mental health (mood) |
Studies involving sight-related interventions | ||||||
Figueiro (2014)45 | Non-controlled before-and-after study | USA | Long-term care facilities | n=14, dementia residents | Bright light interventions Exposed to varying light conditions |
Energy/fatigue (sleep) Mental health (depression) Emotional well-being (agitation) |
Figueiro (2019)46 | Cross-over trial | USA | 4 assisted-living facilities and 4 long-term care facilities | n=46, dementia residents | Bright light interventions | Energy/fatigue (sleep) Mental health (depression) Emotional well-being (agitation) Overall quality of life measure using Minimum Data Set Activities of Daily Living |
Giggins (2019)47 | Pilot RCT | Ireland | 1 nursing home | n=10, cognitive status not reported | Bright light interventions | Energy/fatigue (sleep) Mental health (mood) |
Hopkins (2017)48 | Cross-over trial | UK | 7 care homes | n=80, cognitive status not reported | Bright light interventions | Energy/fatigue (sleep) Mental health (mood) |
Konis (2018)49 | Pilot non-RCT | USA | 8 dementia care communities | n=77, dementia residents | Bright light interventions | Mental health (depression) |
Koyama (1999)50 | Case series | Japan | 2 nursing homes | n=6, cognitive status not reported | Bright light interventions | Energy/fatigue (sleep) |
Linander (2020)51 | Cross-over trial | Denmark | 1 municipality-based care home | n=34, cognitive status not reported | Bright light interventions | Energy/fatigue (sleep) |
Munch (2017)52 | Non-RCT | Switzerland | Nursing home | n=89, dementia residents | Bright light interventions | Quality of Life for Severe Dementia scale Mental health (pleasure) Emotional well-being (agitation) Energy/fatigue (sleep) |
Riemersma-vanderLek (2008)53 | RCT | Netherlands | 12 homes for the elderly/assisted care facilities | n=189, dementia residents | Bright light interventions | Mental health (affect) Energy /fatigue (sleep) Emotional well-being (agitation) |
Sumaya (2001)54 | Cross-over trial | USA | 1 long term care facility | n=10, cognitive status not reported | Bright light interventions | Mental health (depression) |
Wahnschaffe (2017)55 | Non-controlled before-and-after study | Germany | 1 nursing home | n=15, dementia residents | Bright light interventions | Emotional well-being (agitation) |
Wikstrom (1993)56 | Controlled before-and-after | Sweden | 1 senior citizen apartment (moderate needs of assistance) | n=40, no dementia residents | Visual stimulation with pictures (works of art) Engaging in topics of conversation by observing works of art |
Mental health (happy) |
Studies involving smell-related interventions | ||||||
Bae (2020)57 | RCT | USA | 2 long-term care facilities | n=58, no dementia residents | Olfactory stimulation with lavender | Emotional well-being (anxiety) Mental health (depression) Mental health (mood) |
Lin (2007)58 | Cross-over trial | China | Care and attention homes | n=70, dementia residents | Olfactory stimulation with lavender | Emotional well-being (agitation) |
Sakamoto (2012)59 | RCT | Japan | 3 nursing homes | n=145, dementia residents | Olfactory stimulation with lavender | Emotional well-being (agitation) |
Snow (2004)24 | Non-controlled before-and-after study | USA | 1 nursing home | n=7, dementia residents | Olfactory stimulation with lavender Smelling of lavender oils |
Emotional well-being (agitation) |
Studies involving touch-related interventions | ||||||
Alp (2020)60 | RCT | Turkey | 1 nursing home | n=60, no dementia patients | Therapeutic touch | Bodily pain (comfort levels) Emotional well-being (anxiety) |
Butts (2001)20 | RCT | USA | 2 nursing homes | n=45, dementia residents | Massage Regular massage of back, neck and/or shoulders to promote relaxation |
Satisfaction (life satisfaction/self-actualisation) |
Corley (1995)61 | RCT | USA | 1 private institution +1 federal long-term care facility | n=19, cognitive status not reported | Massage | Mental health (mood) |
Gregory (2005)22 | Non-controlled before-and-after study | Australia | Aged care facilities | n=121, cognitive status not reported | Therapeutic touch A structured and standardised healing practice performed by practitioners trained to be sensitive to the receiver’s energy field that surrounds the body; no touching is required. |
Emotional well-being (behavioural symptoms) Pain |
Hawranik (2008)62 | RCT | Canada | 1 long-term care facility | n=51, dementia residents | Therapeutic touch | Emotional well-being (agitation) |
Howard (1988)63 | RCT | USA | 1 nursing home | n=30, cognitive status not reported | Tactile stimulation Touch by the instructor while participating in a craft project |
Mental health (mood) |
Kim (1999)64 | Non-controlled before-and-after study | Korea | 1 home for the aged | n=29, dementia residents | Physical touch | Emotional well-being (anxiety) |
Kolcaba (2006)65 | RCT | USA | 2 nursing homes | n=60, no dementia residents | Massage | Bodily pain (comfort levels) Satisfaction (satisfaction with care) |
Sansone (2000)66 | Case series | USA | 1 nursing centre | n=59, cognitive status not reported | Massage | Emotional well-being (anxiety) Pain |
Simington (1993)67 | RCT | Canada | 2 small +2 large urban long term care facilities | n=105, cognitive status not reported | Therapeutic touch | Emotional well-being (anxiety) |
Wardell (2012)68 69 | Mixed methods: randomised control trial, descriptive qualitative | USA | 5 long-term care facilities | n=20, dementia residents | Therapeutic touch | Overall quality of life measure using EuroQoL 5 Dimension Satisfaction |
Wesenberg (2019)70 | Non-RCT | Germany | 2 nursing homes | n=17, dementia residents | Pet therapy Use of pet visitation |
Mental health (pleasure) Social functioning (non-verbal behaviour and verbal communication) Emotional well-being (agitation) (behavioural symptoms) |
Woods (2005)71 | RCT | USA | 3 special care units in 3 long-term care facilities | n=57, dementia residents | Therapeutic touch | Emotional well-being (behavioural symptoms) |
Bagci (2020)72 | RCT | Turkey | 1 nursing home | n=25, no dementia patients | Therapeutic touch | Energy/fatigue (sleep) |
Yucel (2020)73 | RCT | Turkey | 1 nursing home | n=30 no dementia patients | Therapeutic touch and hand massage | Bodily pain (comfort levels) Emotional well-being (anxiety) |
Studies involving more than one sense-related interventions | ||||||
Alessi (1999) Hearing, Sight, Touch74 |
RCT | USA | 1 community nursing home | n=29, dementia residents | Physical activity program+nighttime programme intervention Fitness sessions throughout the day combined with a quiet environment at night |
Energy/fatigue (sleep) Emotional well-being (agitation) |
Bautrant (2019) Hearing, Sight75 |
Non-controlled before-and-after study | USA | 1 long-term care home | n=19, dementia residents | Environmental modifications Skylike ceiling tiles, decrease of the illuminance at night with soothing music, increase illuminance during the day, light beige walls, oversized clocks, night team clothes dark blue and day team sky blue |
Mental health (depression) Emotional well-being (agitation) (behavioural symptoms) |
Bernstein (2000) Sight, Touch76 |
Cross-sectional | USA | 2 long-term care facilities | n=33, dementia residents | Pet therapy | Social functioning (social behaviours) |
JoyBowles (2002) Smell, Touch25 |
Cross-over trial | Australia | 1 nursing home | n=36, dementia residents | Massage and essential oils | Emotional well-being (agitation) Social functioning (resistance to nursing care) |
Cohen-Mansfield (2012) Hearing, Sight, Touch77 |
Cross-over trial | USA | 7 nursing homes | n=193, dementia residents | Various stimuli interventions Introduction of four stimuli per day (live human social, live pet social, simulated social, inanimate social, reading, manipulative, music, task and work-related, self-identity) |
Mental health (pleasure) |
Cox Hearing, Sight, Smell, Touch18 |
Mixed methods: cross-over trial, descriptive qualitative | Australia | 1 nursing home | n=24, dementia residents | Snoezelen rooms A controlled multisensory environment, a soothing and stimulating environment |
Emotional well-being (anxiety) satisfaction |
Cruz (2011) Hearing, Sight, Smell, Taste, Touch78 |
Non-controlled before-and-after study | Portugal | 1 long-term care home | n=6, dementia residents | Motor and multisensory based strategies Multisensory stimulation such as using a pleasant fragrance, use of relaxing music, gentle massage, flowers. |
Emotional well-being (behavioural symptoms) |
Francis (1986) Hearing, Sight, Touch79 |
Non-controlled before-and-after study | USA | 1 intermediate skilled crse nursing home | n=37, cognitive status not reported | Motor and multisensory based strategies (plush animals) | Mental health (depression) Emotional well-being (agitation) (behavioural symptoms) Social functioning (social behaviours) Satisfaction (life satisfaction/self-actualisation) |
Gillis (2019) Hearing, Touch80 |
Non-controlled before-and-after study | Belgium | 3 nursing homes | n=65, dementia residents | Various stimuli interventions Sessions of therapeutic touch, group music or individual sessions |
Mental health (depression) Emotional well-being (agitation) |
Magee (2017) Hearing, Sight, Smell, Taste, Touch81 |
Cross-sectional | Ireland | 1 nursing home | n=9, dementia residents | Namaste care | Mental health (depression) Emotional well-being (agitation) (behavioural symptoms) |
Maseda (2014) Hearing, Sight, Smell, Touch82 |
RCT | Spain | 1 specialised elderly centre | n=26, dementia residents | Snoezelen rooms | Mental health (depression) Emotional well-being (agitation) (behavioural symptoms) |
Moghaddasifar (2019) Hearing, Sight, Touch83 |
RCT | Iran | Nursing homes | n=28, cognitive status not reported | Motor and multisensory based strategies | Mental health (depression) Emotional well-being (anxiety) |
Roenke (1998) Hearing, Sight, Smell, Touch84 |
Grounded theory | USA | 1 long term care facility | n=4, no dementia residents | Pet therapy | Satisfaction |
Simard (2010) Hearing, Sight, Smell, Taste, Touch85 |
Non-controlled before-and-after study | USA | 6 senior living healthcare centres | n=86, dementia residents | Namaste Care Activities of daily living in an unhurried manner, with a ‘‘loving touch’’ approach to care |
Mental health (depression) Emotional well-being (agitation) (behavioural symptoms) |
Buschmann (1999) Hearing, Touch86 |
RCT | USA | 1 nursing home | n=24, no dementia residents | Expressive physical touch (in combination with talking) A voluntary action that occurs spontaneously and is affective usually on the hand, arm, shoulder, or back |
Mental health (depression) Satisfaction (life satisfaction/self-actualisation) |
Taylor (1993) Hearing, Sight, Smell, Touch87 |
Cross-over trial | USA | 1 long-term care facility | n=18, dementia residents | Pet therapy | Social functioning (Eye contact and vocalisations) |
vanWeert (2005) Hearing, Sight, Smell, Taste, Touch88 89 |
RCT | Netherlands | 6 nursing homes | n=253, dementia residents | Snoezelen rooms | Social functioning (Non-verbal behaviour and verbal communication) |
Witucki (1997) Hearing, Smell, Touch90 |
Cross-sectional | USA | 3 long-term care facilities | n=15, dementia residents | Motor and multisensory based strategies | Emotional well-being (behavioural symptoms) |
RCT, randomised controlled trial.
bmjopen-2020-042466supp003.pdf (256.8KB, pdf)
Characteristics of the included studies
Twenty-three (44.2%) of the 52 articles were conducted in the USA (20, 24, 45, 46, 49, 54, 57, 61, 62, 65, 66, 68/69, 71, 74–77, 79, 84–87, 90), four (7.7%) in Australia,18 22 25 44 three (5.8%) in Turkey,60 72 73 two (3.8%) in Japan,50 59 two (3.8%) in Canada,62 67 two (3.8%) in the Netherlands [53, 88/89], two (3.8%) in Belgium,43 80 two (3.8%) in Germany55 70 and one (1.9%) each in England,42 Ireland,47 UK,48 Denmark,51 Switzerland,52 Sweden,56 China,58 Korea,64 Portugal,78 Ireland,81 Spain82 and Iran.83 A variety of study designs were used including: randomised controlled trials (RCTs) (n=19) (20, 47, 53, 57, 59–63, 65, 67, 71–74, 82, 83, 86, 88/89), non-controlled before and after (n=13),22 24 42–45 55 64 75 78–80 85 cross-over (n=8),25 46 48 51 54 58 77 87 non-RCTs (n=3),49 52 70 cross-sectional (n=3),76 81 90 case series (n=2),50 66 mixed methods (n=2) (18, 68/69), controlled before-and-after (n=1)56 and grounded theory (n=1).84 A total of 32 studies (61.5%) reported the inclusion of participants with cognitive impairment. The study characteristics are found in table 1.
Sensory interventions
Overall, 34 interventions (n=34) targeted only one sense: hearing (n=3), sight (n=12), smell (n=4) and touch (n=15). Eighteen studies (n=18) used a combination of at least two of the senses. No interventions were found specifically addressing taste; however, four interventions involved multiple senses and included taste (n=4). The interventions were grouped into 16 categories (music programmes, environmental white noise, bright light interventions, visual stimulations, olfactory stimulations, massages, therapeutic touch, tactile stimulations, physical activity plus nighttime programmes, pet therapies, various stimuli interventions, Snoezelen rooms, motor and multisensory-based strategies, Namaste care, environmental modifications and expressive touch activities) (see details in table 1).
Outcome measures by senses
The outcome measures were grouped into categories (overall quality of life, is one category and the individual components of quality of life are represented in six categories: mental health, energy/fatigue, emotional well-being, bodily pain, social functioning and satisfaction). Results of the outcomes measures by senses are presented below.
Hearing
Three studies looked at the sense of hearing and used different interventions. One study44 found that their radio programme intervention using the Quality of Life-Alzheimer’s disease significantly improved quality of life for long-term care residents (n=72) (p-value not reported). Their intervention also showed improvement on mental health (mood) (p value and magnitude not reported). The other two studies showed significant improvement in emotional well-being (see details in table 2).
Table 2.
Interventions for the sense of hearing (n=3)
Interventions | N | Outcomes | Direction and magnitude of effect | |
Mental health | Emotional well-being | |||
Environmental ‘white noise’42 | 13 | – | S | Emotional well-being (agitation): −, p≤0.001, magnitude not reported |
Relaxing music during meals43 | 29 | – | S | Emotional well-being (agitation): −, F3, 78 = 8.52; p<0.0001 |
Radio/music programme44 | 72 | NS | – | Quality of Life-Alzheimer’s disease: +, p value and magnitude not reported Mental health (depression): NS |
NS, not significant.
Sight
A total of 12 studies looked at the sense of sight and focused on bright light interventions. Of the 12, six (50%) studies showed a significant improvement in mental health, and two of those studies also showed a significant improvement in energy/fatigue, and emotional well-being. One other studies showed a significant results in emotional well-being (see details in table 3).
Table 3.
Interventions for the sense of sight (n=12)
Interventions | N | Outcomes | Direction and magnitude of effect | ||
Mental health | Energy/fatigue | Emotional well-being | |||
Bright light intervention45 | 14 | S | S | S | Energy/fatigue (sleep): +, p=0.03, magnitude not reported Mental health (depression): −, p=0.03, magnitude not reported Emotional well-being (agitation): −, p=0.03, magnitude not reported |
Bright light interventions46 | 46 | S | S | S | Energy/fatigue (sleep quality): +, F1, 40=14.37; p<0.001 Mental health (depression): −, F1, 40=4.47; p=0.04 Emotional well-being (agitation): −, F1, 40=6.19; p=0.02 Overall quality of life measure using MDS-ADL: F1, 40=1.41; p=0.24 NS |
Bright light interventions47 | 10 | NS | NS | – | Energy/fatigue (sleep): NS Mental health (mood): NS |
Bright light interventions48 | 80 | NS | NS | – | Energy/fatigue (sleep): NS Mental health (mood): NS |
Bright light interventions49 | 77 | S | – | – | Mental health (depression): −, p=0.01, magnitude not reported |
Bright light intervention50 | 6 | – | Mixed | – | Energy/fatigue (sleep): Not reported |
Bright light interventions51 | 34 | – | NS | – | Energy/fatigue (sleep): NS |
Bright light interventions52 | 89 | NS | NS | NS | Quality of Life for Severe Dementia scale: NS Mental health (pleasure): NS Emotional well-being (agitation): NS Energy/fatigue (sleep): NS |
Bright light intervention53 | 189 | S | Mixed | Mixed | Mental health (affect): Light: −, p=0.02, magnitude not reported Energy/fatigue (sleep): Light: NS Light and melatonin: +, p=0.01, magnitude not reported Emotional well-being (agitation): Light: NS, Light and melatonin: −, p=0.01, magnitude not reported |
Bright light intervention54 | 10 | S | – | – | Mental health (depression): +, p<0.01, magnitude not reported |
Bright light interventions55 | 15 | – | – | S | Emotional well-being (agitation): −, p≤0.05, magnitude not reported |
Visual stimulation with pictures (works of art)56 | 40 | S | – | – | Mental health (happy): +, p=0.0001, magnitude not reported |
MDS-ADL, Minimum Data Set Activities of Daily Living; NS, not significant.
Smell
Four studies looked at the sense of smell and focused on olfactory stimulation with lavender. Two studies showed significant results (p=0.04, p<0.0001), while the other two study showed non-significant results for emotional well-being and mental health, respectively. See details in table 4.
Table 4.
Interventions for the sense of smell (n=4)
Interventions | N | Outcomes | Direction and magnitude of effect | |
Mental health | Emotional well-being | |||
Olfactory stimulation with lavender24 | 7 | – | NS | Emotional well-being (agitation): NS |
Olfactory stimulation with lavender57 | 58 | NS | – | Mental health (depression): NS |
Olfactory stimulation with lavender58 | 70 | – | S | Emotional well-being (agitation): −, p<0.001, magnitude not reported |
Olfactory stimulation with lavender59 | 145 | – | S | Emotional well-being (agitation): −, p=0.04, magnitude not reported |
NS, not significant.
Touch
A total of 15 studies looked at the sense of touch and used a variety of interventions. Eight (53%) studies implemented therapeutic touch, with five studies showing significant improvement, one study showing mixed results for emotional well-being, one showing non-significant improvement in overall quality of life and one showing non-significant improvement in energy/fatigue. Another four (27%) studies implemented a massage intervention with mixed results. Only one study implemented physical touch, showing a significant results in emotional well-being (p<0.0001), whereas two other studies implemented a tactile stimulation and a pet therapy intervention respectively, but their findings were non-significant (see details in table 5).
Table 5.
Interventions for the sense of touch (n=15)
Interventions | N | Outcomes | Direction and magnitude of effect | ||||
Mental health | Energy/ Fatigue |
Emotional well-being | Pain | Satisfaction | |||
Massage20 | 45 | – | – | – | – | S | Satisfaction (life satisfaction/self-actualisation): +, p value not reported, magnitude not reported |
Massage61 | 19 | NS | – | – | – | – | Mental health (mood): NS |
Massage65 | 60 | – | – | – | NS | NS | Bodily pain (comfort levels): NS Satisfaction (satisfaction with care): NS |
Massage66 | 59 | – | – | S | S | – | Emotional well-being (anxiety): +, p value not reported, magnitude not reported Pain: −, p value not reported, magnitude not reported |
Therapeutic touch22 | 121 | – | – | S | S | – | Emotional well-being (behavioural symptoms): +, p value not reported, magnitude not reported Pain: −, p value not reported, magnitude not reported |
Therapeutic touch60 | 60 | – | – | S | S | – | Bodily pain (comfort levels): +, X2=107.00, p=0.001 Emotional well-being (anxiety): -, X2=97.171, p≤0.05 |
Therapeutic touch62 | 51 | – | – | Mixed | – | – | Emotional well-being (agitation): Time 0 to Time 5: S, +, p<0.05, Time six to Time 8: NS |
Therapeutic touch67 | 105 | – | – | S | – | – | Emotional well-being (anxiety): +, p=0.001, magnitude not reported |
Therapeutic Touch68 69 | 20 | – | – | – | – | – | Overall quality of life measure using EuroQoL 5 Dimension: NS Qualitative findings: 12 vignettes (one patient each) with quotes were reported, ordered from no perceived benefit to more clear indicators of change |
Therapeutic touch71 | 57 | – | – | S | – | – | Emotional well-being (behavioural symptoms): -, p=0.033, magnitude not reported |
Therapeutic touch72 | 25 | – | NS | – | – | – | Energy/fatigue (sleep): NS |
Therapeutic touch and hand massage73 | 30 | – | – | S | S | Bodily pain (comfort levels): +, p≤0.05, magnitude not reported Emotional well-being (anxiety): -, p≤0.05, magnitude not reported |
|
Physical Touch64 | 29 | – | – | S | – | – | Emotional well-being (anxiety): -, p<0.0001, magnitude not reported |
Pet therapy70 | 17 | Mental health (pleasure): +, p<0.01, magnitude not reported Social functioning (Non-verbal behaviour and verbal communication) : NS Emotional well-being (agitation) (behavioural symptoms): NS |
|||||
Tactile stimulation63 | 30 | NS | – | – | – | – | Mental health (mood): NS |
NS, not significant.
Multiple senses
A total of 18 studies looked at multiple senses and used a variety of interventions including a physical activity combined with a nighttime intervention programme (n=1), a massage intervention (n=1), various stimuli interventions (n=2), motor and multisensory-based strategies (n=4), Snoezelen rooms (n=3), Namaste care (n=2), expressive physical touch (in combination with talking) (n=1), pet therapy (n=3) and environmental modifications (n=1). For the four studies implementing motor and multisensory-based strategies, three showed significant results. For the three studies implementing Snoezelen rooms, and the three studies implementing pet therapy, all showed mixed results (see details in table 6).
Table 6.
Interventions for multiple senses (n=18)
Interventions (senses) | N | Outcomes | Direction and magnitude of effect | ||||
Mental health | Energy/ Fatigue |
Emotional well-being | Social functioning | Satisfaction | |||
Massage25 | 36 | – | – | S | S | – | Emotional well-being (agitation): +, p=0.0364, magnitude not reported Social functioning (resistance to nursing care): −, p=0.0026, magnitude not reported |
Physical activity program +night-time programme intervention74 | 29 | – | S | S | – | – | Energy/fatigue (sleep): +, p=0.045, magnitude not reported Emotional well-being (agitation): +, p=0.009, magnitude not reported |
Various stimuli interventions77 | 193 | Mixed | – | – | – | – | Mental health (pleasure): Live human social: +, p<0.001 Real pet: +, p<0.001 Simulated social: +, p<0.001 Self-identity: +, p<0.001 Inanimate social: +, p<0.001 Music: +, p<0.05, magnitude not reported Manipulative: NS Reading: NS Task/work related: NS |
Various stimuli interventions80 | 65 | S | – | S | – | – | Mental health (depression): −, p=0.008 Emotional well-being (agitation): -, p<0.001 |
Motor and multisensory based strategies78 | 6 | – | – | NS | – | – | Emotional well-being (behavioural symptoms): NS |
Motor and multisensory based strategies (Plush animals)79 | 40 | S | – | S | S | S | Mental health (depression): -, p<0.049, magnitude not reported Emotional well-being: +, p<0.001, magnitude not reported (behavioural symptoms) Social functioning (social behaviours): +, p<0.006, magnitude not reported Satisfaction (life satisfaction/self-actualisation): +, p<0.030, magnitude not reported |
Motor and multisensory based strategies83 | 28 | S | – | S | – | – | Mental health (depression): +, p>0.001, magnitude not reported Emotional well-being (anxiety): −, p=0.001, magnitude not reported |
Motor and multisensory based strategies90 | 15 | – | – | S | – | – | Emotional well-being (behavioural symptoms): −, p, magnitude not reported |
Snoezelen rooms18 | 24 | – | – | NS | – | – | Emotional well-being (anxiety): NS |
Snoezelen rooms82 | 26 | NS | – | Mixed | – | – | Mental health (depression): NS Emotional well-being (agitation): +, p=0.023, magnitude not reported (behavioural symptoms): NS |
Snoezelen rooms88 89 | 253 | – | – | – | S | – | Social functioning (Non-verbal behaviour and verbal communication): +, p<0.05, magnitude not reported |
Namaste Care81 | 9 | NS | – | NS | – | – | Mental health (depression): NS Emotional well-being (agitation): NS Emotional well-being (behavioural symptoms): NS |
Namaste Care85 | 86 | NS | – | NS | – | – | Mental health (depression): NS Emotional well-being (agitation): NS (behavioural symptoms): NS |
Expressive physical touch (in combination with talking)86 | 24 | S | – | – | – | S | Mental health (depression): −, t=−3.07, p=0.005 Satisfaction (life satisfaction/self-actualisation): +, p<0.004, magnitude not reported |
Pet therapy76 | 33 | – | – | – | S | – | Social functioning (social behaviours): +, p<0.01, magnitude not reported |
Pet therapy84 | 4 | – | – | – | – | – | The four themes were: (1) humanness (the human component) (2) anticipation and continuity (3) ability to facilitate reminiscence: (4) social aspects. |
Pet therapy87 | 18 | – | – | – | NS | – | Social functioning (eye contact and vocalisations): NS |
Environmental modifications75 | 19 | NS | – | S | – | – | Mental health (depression): NS Emotional well-being (agitation): -, p=0.039, magnitude not reported Emotional well-being (behavioural symptoms): −, p<0.026, magnitude not reported |
NS, not significant.
Discussion
Key findings
In this scoping review, we identified 52 primary studies exploring the relationship between sensory interventions and the quality of life of residents living in long-term care settings. Four studies (44, 46, 52, 68/69) assessed an overall quality of life measure and 48 studies (n=48) examined individual components of quality of life.
We found that there were many interventions that relate to the five senses. We grouped these interventions into 16 categories as follows: music programmes, environmental white noise, bright light interventions, visual stimulations, olfactory stimulations, massages, therapeutic touch, tactile stimulations, physical activity plus nighttime programmes, pet therapies, various stimuli interventions, Snoezelen rooms, motor and multisensory based strategies, Namaste care, environmental modifications and expressive touch activities. These categories will be helpful to inform the design of a future series of systematic reviews related to the five senses.
In our current scoping review, we identified some promising interventions that showed improvement in one of the quality of life components based on the senses: (1) Hearing: One study implemented a radio/music programme intervention that showed improvement in overall quality of life,44 two other studies implementing white noise42 and relaxing music during meals,43 both showed improvement in emotional well-being, (2) Sight: 6 out of 12 (50%) studies showed an improvement in mental health45 46 49 53 54 56 and two of these studies also showed an improvement in energy/fatigue and emotional well-being,45 46 (3) Smell: Two out of four studies showed a significant improvement in emotional well-being,58 59 (4) Touch: 5 of 15 studies (33%) implementing a therapeutic touch intervention showed a significant improvement in emotional well-being,22 60 67 71 73 (5) Taste: No interventions were found to address taste specifically. Furthermore, a total of 18 studies examined multiple senses. Of these studies, four studies implemented motor and multisensory-based strategies, three showing significant results,79 83 90 three studies implemented Snoezelen rooms (18, 82, 88/89) and three studies implemented pet therapy,76 84 87 all showing mixed results. Overall, the studies were of poor quality demonstrating the need for further, more robust research in this area.
Strengths and limitations
Despite the rigorous methods used in this review, there were limitations. First, there was a major limitation in the search strategy. Only studies that mentioned one of the five senses specifically were identified in the search. This was done to increase the sensitivity and specificity of the search; however, the results may not be reflective of all interventions that are designed to impact the senses. For example, pet therapy, or massage therapy were not included as terms in the search strategy. Second, we only searched a few databases, and as such, this review may not contain all the work completed on this topic. Third, since this was a scoping review, the reference lists of included articles as well as grey literature were not hand-searched. Finally, in the analysis, we used a vote counting approach to synthesise the data. Vote counting has its limitations as it does not take into account the difference in weights given to each study and it does not take into account estimates of the effect size.91 Thus, a series of systematic reviews for all the sensory interventions identified could be conducted to further explore these areas.
Comparison with previous research
Although previous studies have looked at sensory decline and decreased quality of life,4–13 and at interventions related to the senses,14–32 this is the first review specifically looking at sensory interventions for older adults with a general decline of the senses living in long-term care.
Previous work in hospital settings by Maria Ugolini et al92 support the importance of incorporating the five senses in the care of patients. Their proposed model identified the important role that the physical environment has on the healing process of patients and the need for improvement actions focused on the sensory perception of their patients. Similarly, a narrative review by Iyendo et al93 of 195 studies also acknowledged the importance of the physical hospital environment and its impact on wellness. The authors reported that a calm well-designed hospital interior with natural lighting, landscaped gardens and colourful art can reduce stressful conditions and creates a better healing environment.
Overall, research findings acknowledge the importance of the environment on supporting residents with sensory impairments to perform safely their activities of daily living. A scoping review94 of 51 studies in long-term care settings identified key barriers to managing two of the five senses, hearing and vision losses (ie, lack of staff knowledge, poor management of assistive aids, unsuitable environment) and the need to implement best practices. They identified six themes including knowledge, assistive devices, screening tools, external organisations, the environment and cognition. Yet, the implementation of sensory interventions require time and cost to long-term care organisations, which may create some challenges in their broad uptake. Specific guidelines are needed for designing long-term care homes to support residents with sensory losses, and specifically to improve the quality of life of residents living in long-term care settings.
Conclusion
Understanding sensory interventions in long-term care settings remains a relatively new research topic, and there is a paucity of literature that investigates all five senses. This scoping review summarised some of the available sensory interventions, that will help inform a series of future systematic reviews on each of the specific interventions.
The scoping review findings will inform the development of the preliminary content of an audit tool for long-term care organisations to use in assessing their sensory environment and in determining the relationship between sensory interventions and the quality of life of their residents. These results are relevant for policy makers, decision-makers, clinicians and residents/families in long-term care settings.
Supplementary Material
Acknowledgments
We would like to thank Lindsey Sikora (LS) for developing the search strategy.
Footnotes
Contributors: All authors (CB, MD-V, DC-Y, MC and JS) contributed to conceptualising and designing the study. MD-V, DC-Y and MC independently performed screening. MD-V and DC-Y independently performed data extraction. CB performed initial data synthesis and JS refined it. CB drafted the manuscript. All authors (MD-V, DC-Y, MC, JS) critically appraised and edited the manuscript. All authors read and approved the final manuscript. CB is the guarantor of the review.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: None declared.
Patient consent for publication: Not required.
Provenance and peer review: Not commissioned; externally peer reviewed.
Data availability statement: All data relevant to the study are included in the article or uploaded as online supplemental information.
Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
References
- 1.United Nations . World population prospects 2019. Available: https://population.un.org/wpp/
- 2.Novak M. Aging and society: a Canadian perspective. Nelson, Canada; 2013. [Google Scholar]
- 3.Pohl PS, Dunn W, Brown C. The role of sensory processing in the everyday lives of older adults. OTJR 2003;23:99–106. 10.1177/153944920302300303 [DOI] [Google Scholar]
- 4.Fischer ME, Cruickshanks KJ, Klein BEK, et al. Multiple sensory impairment and quality of life. Ophthalmic Epidemiol 2009;16:346–53. 10.3109/09286580903312236 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Pinto JM, Wroblewski KE, Kern DW, et al. Olfactory dysfunction predicts 5-year mortality in older adults. PLoS One 2014;9:e107541. 10.1371/journal.pone.0107541 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Wilson RS, Yu L, Bennett DA. Odor identification and mortality in old age. Chem Senses 2011;36:63–7. 10.1093/chemse/bjq098 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Wang JJ, et al. Visual impairment, age-related cataract, and mortality. Arch Ophthal 2001;119:1186–90. 10.1001/archopht.119.8.1186 [DOI] [PubMed] [Google Scholar]
- 8.Rovner BW, Ganguli M. Depression and disability associated with impaired vision: the movies project. J Am Geriatr Soc 1998;46:617–9. 10.1111/j.1532-5415.1998.tb01080.x [DOI] [PubMed] [Google Scholar]
- 9.Klaver CCW, et al. Age-Specific prevalence and causes of blindness and visual impairment in an older population. Arch Ophthal 1998;116:653–8. 10.1001/archopht.116.5.653 [DOI] [PubMed] [Google Scholar]
- 10.Li L, Simonsick EM, Ferrucci L, et al. Hearing loss and gait speed among older adults in the United States. Gait Posture 2013;38:25–9. 10.1016/j.gaitpost.2012.10.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Genther DJ, Betz J, Pratt S, et al. Association of hearing impairment and mortality in older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2015;70:85–90. 10.1093/gerona/glu094 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Schiffman SS, Graham BG. Taste and smell perception affect appetite and immunity in the elderly. Eur J Clin Nutr 2000;54 Suppl 3:S54–63. 10.1038/sj.ejcn.1601026 [DOI] [PubMed] [Google Scholar]
- 13.Besné I, Descombes C, Breton L. Effect of age and anatomical site on density of sensory innervation in human epidermis. Arch Dermatol 2002;138:1445–50. 10.1001/archderm.138.11.1445 [DOI] [PubMed] [Google Scholar]
- 14.De Lepeleire J, Bouwen A, De Coninck L, et al. Insufficient lighting in nursing homes. J Am Med Dir Assoc 2007;8:314–7. 10.1016/j.jamda.2007.01.003 [DOI] [PubMed] [Google Scholar]
- 15.Mendes A, Papoila AL, Carreiro-Martins P, et al. The influence of thermal comfort on the quality of life of nursing home residents. J Toxicol Environ Health A 2017;80:729–39. 10.1080/15287394.2017.1286929 [DOI] [PubMed] [Google Scholar]
- 16.Dijkstra K, Pieterse M, Pruyn A. Physical environmental stimuli that turn healthcare facilities into healing environments through psychologically mediated effects: systematic review. J Adv Nurs 2006;56:166–81. 10.1111/j.1365-2648.2006.03990.x [DOI] [PubMed] [Google Scholar]
- 17.Fredriksson A-C, Hellström L, Nilsson U. Patients’ perception of music versus ordinary sound in a postanaesthesia care unit: A randomised crossover trial. Intensive and Critical Care Nursing 2009;25:208–13. 10.1016/j.iccn.2009.04.002 [DOI] [PubMed] [Google Scholar]
- 18.Cox H, Burns I, Savage S. Multisensory environments for leisure: promoting well-being in nursing home residents with dementia. J Gerontol Nurs 2004;30:37–45. 10.3928/0098-9134-20040201-08 [DOI] [PubMed] [Google Scholar]
- 19.Weisberg J, Haberman MR. A therapeutic Hugging week in a geriatric facility. J Gerontol Soc Work 1989;13:181–6. 10.1300/J083V13N03_13 [DOI] [Google Scholar]
- 20.Butts JB. Outcomes of comfort touch in institutionalized elderly female residents. Geriatr Nurs 2001;22:180–4. 10.1067/mgn.2001.117914 [DOI] [PubMed] [Google Scholar]
- 21.Fraser J, Ross Kerr J. Psychophysiological effects of back massage on elderly institutionalized patients. J Adv Nurs 1993;18:238–45. 10.1046/j.1365-2648.1993.18020238.x [DOI] [PubMed] [Google Scholar]
- 22.Gregory S, Verdouw J. Therapeutic touch: its application for residents in aged care. Aust Nurs J 2005;12:23–5. [PubMed] [Google Scholar]
- 23.Baun MM, Bergstrom N, Langston NF, et al. Physiological effects of human/companion animal bonding. Nurs Res 1984;33:126–9. 10.1097/00006199-198405000-00002 [DOI] [PubMed] [Google Scholar]
- 24.Snow LA, Hovanec L, Brandt J. A controlled trial of aromatherapy for agitation in nursing home patients with dementia. J Altern Complement Med 2004;10:431–7. 10.1089/1075553041323696 [DOI] [PubMed] [Google Scholar]
- 25.Joy Bowles E, Bowles J, Griffiths Q. Effects of essential oils and touch on resistance to nursing care procedures and other dementia-related behaviours in a residential care facility. International Journal of Aromatherapy 2002;12:22–9. 10.1054/ijar.2001.0128 [DOI] [Google Scholar]
- 26.Adams K, Anderson JB, Archuleta M, et al. Defining skilled nursing facility residents' dining style preferences. J Nutr Gerontol Geriatr 2013;32:213–32. 10.1080/21551197.2013.810560 [DOI] [PubMed] [Google Scholar]
- 27.Bautista EN, Tanchoco CC, Tajan MG, et al. Effect of flavor enhancers on the nutritional status of older persons. J Nutr Health Aging 2013;17:390–2. 10.1007/s12603-012-0438-9 [DOI] [PubMed] [Google Scholar]
- 28.Cassens D, Johnson E, Keelan S. Enhancing taste, texture, appearance, and presentation of Pureed food improved resident quality of life and weight status. Nutr Rev 1996;54:S51–4. 10.1111/j.1753-4887.1996.tb03790.x [DOI] [PubMed] [Google Scholar]
- 29.Hartwell H, Johns N, Edwards JSA. E-menus—Managing choice options in hospital foodservice. Int J Hosp Manag 2016;53:12–16. 10.1016/j.ijhm.2015.11.007 [DOI] [Google Scholar]
- 30.O'hara PA, Harper DW, Kangas M, et al. Taste, temperature, and presentation predict satisfaction with foodservices in a Canadian continuing-care Hospital. J Am Diet Assoc 1997;97:401–5. 10.1016/S0002-8223(97)00100-4 [DOI] [PubMed] [Google Scholar]
- 31.Ohno T, Uematsu H, Nozaki S, et al. Improvement of taste sensitivity of the nursed elderly by oral care. J Med Dent Sci 2003;50:101–7. [PubMed] [Google Scholar]
- 32.Baur V, Abma T. ‘The Taste Buddies’: participation and empowerment in a residential home for older people. Ageing Soc 2012;32:1055–78. 10.1017/S0144686X11000766 [DOI] [Google Scholar]
- 33.Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8:19–32. 10.1080/1364557032000119616 [DOI] [Google Scholar]
- 34.Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169:467–73. 10.7326/M18-0850 [DOI] [PubMed] [Google Scholar]
- 35.Backman C, Crick M, Cho-Young D, et al. What is the impact of sensory practices on the quality of life of long-term care residents? A mixed-methods systematic review protocol. Syst Rev 2018;7:115. 10.1186/s13643-018-0783-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.McGowan J, Sampson M, Salzwedel DM, et al. Press peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 2016;75:40–6. 10.1016/j.jclinepi.2016.01.021 [DOI] [PubMed] [Google Scholar]
- 37.World Health Organization . Proposed working definition of an older person in Africa for the MDS project. Available: http://www.who.int/healthinfo/survey/ageingdefnolder/en/
- 38.Sanford AM, Orrell M, Tolson D, et al. An international definition for "nursing home". J Am Med Dir Assoc 2015;16:181–4. 10.1016/j.jamda.2014.12.013 [DOI] [PubMed] [Google Scholar]
- 39.Office of Disease Prevention and Health Promotion . Health-Related Quality of Life & Well-Being. Available: https://www.healthypeople.gov/2020/topics-objectives/topic/health-related-quality-of-life-well-being
- 40.Rand Health Care . 36-Item short form survey (SF-36). Available: https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form/scoring.html
- 41.Covidence . A Cochrane technology program. Available: https://www.covidence.org/
- 42.Burgio L, Scilley K, Hardin JM, et al. Environmental "white noise": an intervention for verbally agitated nursing home residents. J Gerontol B Psychol Sci Soc Sci 1996;51:P364–73. 10.1093/geronb/51B.6.P364 [DOI] [PubMed] [Google Scholar]
- 43.Goddaer J, Abraham IL. Effects of relaxing music on agitation during meals among nursing home residents with severe cognitive impairment. Arch Psychiatr Nurs 1994;8:150–8. 10.1016/0883-9417(94)90048-5 [DOI] [PubMed] [Google Scholar]
- 44.Travers C, Bartlett HP. Silver memories: implementation and evaluation of a unique radio program for older people. Aging Ment Health 2011;15:169–77. 10.1080/13607863.2010.508774 [DOI] [PubMed] [Google Scholar]
- 45.Figueiro MG, Plitnick BA, Lok A, et al. Tailored lighting intervention improves measures of sleep, depression, and agitation in persons with Alzheimer's disease and related dementia living in long-term care facilities. Clin Interv Aging 2014;9:1527. 10.2147/CIA.S68557 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Figueiro MG, Plitnick B, Roohan C, et al. Effects of a tailored lighting intervention on sleep quality, Rest-Activity, mood, and behavior in older adults with Alzheimer disease and related dementias: a randomized clinical trial. J Clin Sleep Med 2019;15:1757–67. 10.5664/jcsm.8078 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47.Giggins OM, Doyle J, Hogan K, et al. The impact of a cycled lighting intervention on nursing home residents: a pilot study. Gerontol Geriatr Med 2019;5:233372141989745. 10.1177/2333721419897453 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Hopkins S, Morgan PL, Schlangen LJM, et al. Blue-Enriched lighting for older people living in care homes: effect on activity, Actigraphic sleep, mood and alertness. Curr Alzheimer Res 2017;14:1053–62. 10.2174/1567205014666170608091119 [DOI] [PubMed] [Google Scholar]
- 49.Konis K, Mack WJ, Schneider EL. Pilot study to examine the effects of indoor daylight exposure on depression and other neuropsychiatric symptoms in people living with dementia in long-term care communities. Clin Interv Aging 2018;13:1071–7. 10.2147/CIA.S165224 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 50.Koyama E, Matsubara H, Nakano T. Bright light treatment for sleep-wake disturbances in aged individuals with dementia. Psychiatry Clin Neurosci 1999;53:227–9. 10.1046/j.1440-1819.1999.00483.x [DOI] [PubMed] [Google Scholar]
- 51.Linander CB, Kallemose T, Joergensen LM, et al. The effect of circadian-adjusted LED-based lighting on sleep, daytime sleepiness and biomarkers of inflammation in a randomized controlled cross-over trial by pragmatic design in elderly care home dwellers. Arch Gerontol Geriatr 2020;91:104223. 10.1016/j.archger.2020.104223 [DOI] [PubMed] [Google Scholar]
- 52.Münch M, Schmieder M, Bieler K, et al. Bright light delights: effects of daily light exposure on emotions, Restactivity cycles, sleep and melatonin secretion in severely demented patients. Curr Alzheimer Res 2017;14:1063–75. 10.2174/1567205014666170523092858 [DOI] [PubMed] [Google Scholar]
- 53.Riemersma-van der Lek RF, et al. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities. JAMA 2008;299:2642–55. 10.1001/jama.299.22.2642 [DOI] [PubMed] [Google Scholar]
- 54.Sumaya IC, Rienzi BM, Deegan JF, et al. Bright light treatment decreases depression in institutionalized older adults: a placebo-controlled crossover study. J Gerontol A Biol Sci Med Sci 2001;56:M356–60. 10.1093/gerona/56.6.M356 [DOI] [PubMed] [Google Scholar]
- 55.Wahnschaffe A, Nowozin C, Haedel S, et al. Implementation of dynamic lighting in a nursing home: impact on agitation but not on Rest-Activity patterns. Curr Alzheimer Res 2017;14:1076–83. 10.2174/1567205014666170608092411 [DOI] [PubMed] [Google Scholar]
- 56.Wikström B-M, Theorell T, Sandström S. Medical health and emotional effects of art stimulation in old age. Psychother Psychosom 1993;60:195–206. 10.1159/000288693 [DOI] [PubMed] [Google Scholar]
- 57.Bae S, Asojo AO. Ambient scent as a positive distraction in long-term care units: theory of supportive design. HERD 2020;13:158–72. 10.1177/1937586720929021 [DOI] [PubMed] [Google Scholar]
- 58.Lin PW-ki, Chan W-chi, Ng BF-leung, et al. Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: a cross-over randomized trial. Int J Geriatr Psychiatry 2007;22:405–10. 10.1002/gps.1688 [DOI] [PubMed] [Google Scholar]
- 59.Sakamoto Y, Ebihara S, Ebihara T, et al. Fall prevention using olfactory stimulation with lavender odor in elderly nursing home residents: a randomized controlled trial. J Am Geriatr Soc 2012;60:1005–11. 10.1111/j.1532-5415.2012.03977.x [DOI] [PubMed] [Google Scholar]
- 60.Alp FY, Yucel SC. The effect of therapeutic touch on the comfort and anxiety of nursing home residents. J Relig Health 2020;7. 10.1007/s10943-020-01025-4. [Epub ahead of print: 15 May 2020]. [DOI] [PubMed] [Google Scholar]
- 61.Corley MC, Ferriter J, Zeh J, et al. Physiological and psychological effects of back rubs. Appl Nurs Res 1995;8:39–42. 10.1016/S0897-1897(95)80305-X [DOI] [PubMed] [Google Scholar]
- 62.Hawranik P, Johnston P, Deatrich J. Therapeutic touch and agitation in individuals with Alzheimer’s disease. West J Nurs Res 2008;30:417–34. 10.1177/0193945907305126 [DOI] [PubMed] [Google Scholar]
- 63.Howard DM. The effects of touch in the geriatric population. Phys Occup Ther Geriatr 1988;6:35–50. 10.1080/J148V06N02_05 [DOI] [Google Scholar]
- 64.Kim EJ, Buschmann MT. The effect of expressive physical touch on patients with dementia. Int J Nurs Stud 1999;36:235–43. 10.1016/S0020-7489(99)00019-X [DOI] [PubMed] [Google Scholar]
- 65.Kolcaba K, Schirm V, Steiner R. Effects of hand massage on comfort of nursing home residents. Geriatr Nurs 2006;27:85–91. 10.1016/j.gerinurse.2006.02.006 [DOI] [PubMed] [Google Scholar]
- 66.Sansone P, Schmitt L. Providing tender touch massage to elderly nursing home residents: a demonstration project. Geriatr Nurs 2000;21:303–8. 10.1067/mgn.2000.108261 [DOI] [PubMed] [Google Scholar]
- 67.Simington JA, Laing GP. Effects of therapeutic touch on anxiety in the institutionalized elderly. Clin Nurs Res 1993;2:438–50. 10.1177/105477389300200406 [DOI] [PubMed] [Google Scholar]
- 68.Wardell DW, Decker SA, Engebretson JC. Healing touch for older adults with persistent pain. Holist Nurs Pract 2012;26:194–202. 10.1097/HNP.0b013e318258528d [DOI] [PubMed] [Google Scholar]
- 69.Decker S, Wardell DW, Cron SG. Using a healing touch intervention in older adults with persistent pain: a feasibility study. J Holist Nurs 2012;30:205–13. 10.1177/0898010112440884 [DOI] [PubMed] [Google Scholar]
- 70.Wesenberg S, Mueller C, Nestmann F, et al. Effects of an animal‐assisted intervention on social behaviour, emotions, and behavioural and psychological symptoms in nursing home residents with dementia. Psychogeriatrics 2019;19:219–27. 10.1111/psyg.12385 [DOI] [PubMed] [Google Scholar]
- 71.Woods DL, Craven RF, Whitney J. The effect of therapeutic touch on behavioral symptoms of persons with dementia. Altern Ther Health Med 2005;11:66–74. [PubMed] [Google Scholar]
- 72.Bağcı H, Çınar Yücel Şebnem. Effect of therapeutic touch on sleep quality in elders living at nursing homes. J Relig Health 2020;59:1304–18. 10.1007/s10943-019-00831-9 [DOI] [PubMed] [Google Scholar]
- 73.Yücel Şebnem Çınar, Arslan GG, Bagci H. Effects of hand massage and therapeutic touch on comfort and anxiety living in a nursing home in turkey: a randomized controlled trial. J Relig Health 2020;59:351–64. 10.1007/s10943-019-00813-x [DOI] [PubMed] [Google Scholar]
- 74.Alessi CA, Yoon EJ, Schnelle JF, et al. A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve? J Am Geriatr Soc 1999;47:784–91. 10.1111/j.1532-5415.1999.tb03833.x [DOI] [PubMed] [Google Scholar]
- 75.Bautrant T, Grino M, Peloso C, et al. Impact of environmental modifications to enhance day-night orientation on behavior of nursing home residents with dementia. J Am Med Dir Assoc 2019;20:377–81. 10.1016/j.jamda.2018.09.015 [DOI] [PubMed] [Google Scholar]
- 76.Bernstein PL, Friedmann E, Malaspina A. Animal-assisted therapy enhances resident social interaction and initiation in long-term care facilities. Anthrozoös 2000;13:213–24. 10.2752/089279300786999743 [DOI] [Google Scholar]
- 77.Cohen-Mansfield J, Marx MS, Freedman LS, et al. What affects Pleasure in persons with advanced stage dementia? J Psychiatr Res 2012;46:402–6. 10.1016/j.jpsychires.2011.12.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 78.Cruz J, Marques A, Barbosa AL, et al. Effects of a motor and multisensory-based approach on residents with moderate-to-severe dementia. American J Alzheimers Dis Other Demen 2011;26:282–9. 10.1177/1533317511411177 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 79.Francis G, Baly A. Plush animals--do they make a difference? Geriatr Nurs 1986;7:140–2. 10.1016/S0197-4572(86)80034-9 [DOI] [PubMed] [Google Scholar]
- 80.Gillis K, Lahaye H, Dom S, et al. A person-centred team approach targeting agitated and aggressive behaviour amongst nursing home residents with dementia using the senses framework. Int J Older People Nurs 2019;14:e12269. 10.1111/opn.12269 [DOI] [PubMed] [Google Scholar]
- 81.Magee M, McCorkell G, Guille S, et al. Feasibility of the Namaste care programme to enhance care for those with advanced dementia. Int J Palliat Nurs 2017;23:368–76. 10.12968/ijpn.2017.23.8.368 [DOI] [PubMed] [Google Scholar]
- 82.Maseda A, Sánchez A, Marante MP, et al. Effects of multisensory stimulation on a sample of institutionalized elderly people with dementia diagnosis: a controlled longitudinal trial. Am J Alzheimers Dis Other Demen 2014;29:463–73. 10.1177/1533317514522540 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 83.Moghaddasifar I, Fereidooni-Moghadam M, Fakharzadeh L, et al. Investigating the effect of multisensory stimulation on depression and anxiety of the elderly nursing home residents: a randomized controlled trial. Perspect Psychiatr Care 2019;55:42–7. 10.1111/ppc.12285 [DOI] [PubMed] [Google Scholar]
- 84.Roenke L, Mulligan S. The therapeutic value of the human-animal connection. Occup Ther Health Care 1998;11:27–43. 10.1080/J003v11n02_03 [DOI] [PubMed] [Google Scholar]
- 85.Simard J, Volicer L. Effects of Namaste care on residents who do not benefit from usual activities. Am J Alzheimers Dis Other Demen 2010;25:46–50. 10.1177/1533317509333258 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 86.Buschmann MT, Hollinger-Smith LM, Peterson-Kokkas SE. Implementation of expressive physical touch in depressed older adults. J Clin Geropsychol 1999;5:291–300. 10.1023/A:1022915024768 [DOI] [Google Scholar]
- 87.Taylor E, Maser S, Yee J, et al. Effect of animals on eye contact and vocalizations of elderly residents in a long term care facility. Phys & Ther Geriatr 1994;11:61–71. 10.1080/J148V11N04_05 [DOI] [Google Scholar]
- 88.van Weert JCM, van Dulmen AM, Spreeuwenberg PMM, et al. Effects of snoezelen, integrated in 24h dementia care, on nurse–patient communication during morning care. Patient Educ Couns 2005;58:312–26. 10.1016/j.pec.2004.07.013 [DOI] [PubMed] [Google Scholar]
- 89.van Weert JCM, van Dulmen AM, Spreeuwenberg PMM, et al. Behavioral and mood effects of snoezelen integrated into 24-hour dementia care. J Am Geriatr Soc 2005;53:24–33. 10.1111/j.1532-5415.2005.53006.x [DOI] [PubMed] [Google Scholar]
- 90.Witucki JM, Twibell RS. The effect of sensory stimulation activities on the psychological well being of patients with advanced Alzheimer’s disease. Am J Alzheimers Dis 1997;12:10–15. 10.1177/153331759701200103 [DOI] [Google Scholar]
- 91.Grimshaw J, McAuley LM, Bero LA, et al. Systematic reviews of the effectiveness of quality improvement strategies and programmes. Qual Saf Health Care 2003;12:298–303. 10.1136/qhc.12.4.298 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 92.Maria Ugolini M, Rossato C, Baccarani C. A five-senses perspective to quality in hospitals. The TQM Journal 2014;26:284–99. 10.1108/TQM-01-2014-0010 [DOI] [Google Scholar]
- 93.Iyendo TO, Uwajeh PC, Ikenna ES. The therapeutic impacts of environmental design interventions on wellness in clinical settings: a narrative review. Complement Ther Clin Pract 2016;24:174–88. 10.1016/j.ctcp.2016.06.008 [DOI] [PubMed] [Google Scholar]
- 94.Andrusjak W, Barbosa A, Mountain G. Identifying and managing hearing and vision loss in older people in care homes: a scoping review of the evidence. Gerontologist 2020;60:e155–68. 10.1093/geront/gnz087 [DOI] [PubMed] [Google Scholar]
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Supplementary Materials
bmjopen-2020-042466supp001.pdf (1.5MB, pdf)
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