Active Ageing in nursing homes: a multimethod design towards implementation

Since its introduction by the World Health Organization (WHO)1 in 2002 Active Ageing (AA) has become a widespread concept. It is the “process of optimizing opportunities for health, participation and security in order to enhance the quality of life (QoL) as people age”. Nevertheless its importance, research on AA is only directed to community-dwellers and people in nursing homes (NH) are left out. AA is, however, a right of all1. Therefore, the general aim of this project was to translate and implement AA1 to the NH. The first objective was to examine the relevance and to translate AA1 to the NH. An exploratory qualitative study with four focus groups (residents with no dementia (NHR), children of NHR, community-dwelling older people and experts) and a thematic analysis was performed. AA was seen as relevant for the NH. Nine AA determinants were identified. Seven were analogue to those of the WHO and two new arose, meaningful leisure and participation. Participation appear-ed the central element in the NH AA model. Since AA aims to optimize the QoL, the second objective was systematically reviewing interventions done in NH to enhance NHR’ QoL. We identified 35 interventions, which could all be assigned to one or more AA determinants, mainly to the determinants reflecting physical and psychological factors. The methodological qualitywas low. Effects on QoL were not systematically present. The third aim was to examine to which extent Flemish NH were working on AA. An AA-survey wasdeveloped for NHR. Also the Anamnestic Comparative Self-Assessment (ACSA), a QoL questionnaire, was administered. A representative random sample of 383 NHR was recruited (stratification on NH level). The reliable AA-survey (Cronbach’s α=0,87) showed a significant positive correlation with ACSA (r=0,349, p<0,05). NHR reported a positive QoL (ACSA range -5-+5, x̅=1,75) and were for 73% satisfied with the AA-operation (Figure 2). Meaningful leisure, participation and social environment scored, however, lower than 70%. Private profit NH scored significantly lower on different determinants compared to private, non-profit NH. The fourth goal contained the implementation of an AA strategy within the NH in a randomizedcontrolled trial. As intervention, focusing on the NHR’ participation, we introduced participatory action research (PAR), an empowering method where 10 NHR gather weekly to analyze their life situation and make suggestions for improvement which are implemented by the NH. There were three conditions, the PAR Intervention (I), an active control (AC) condition with another weekly activity (reminiscence) and a passive control (PC) with care as usual. These conditions were randomly allocated to three selected NH. The intervention took 6 months, with 6 months follow-up. As outcomes, the experienced AA-operation, the QoL and the participation level were measured. Per NH, 30 NHR were assessed three times (pre, post and follow up measurements), including the 10 participants from the INH (PAR) and ACNH (reminiscence). Preliminary results indicate no demographic differences between the NHR of the three NH at pre-test. Over time, there was no significant change in QoL in none of the NH nor in the PAR-group. There was, however, over time a decrease in satisfaction on the AA-operation (p<0,05) in the 3 NH, except for the PAR-group, where the scores remained stable.