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Background: Having more freedom of movement may relate to better health in nursing home (NH) residents with dementia. Research that tests whether residents in NHs with more freedom of movement are healthier compared to residents in closed NHs is scarce. Also, existing research on freedom of movement does not consider the diverse dimensions of health. This study explored health differences between two groups of nursing home residents with dementia with different levels of freedom of movement. Methods: We used a quantitative cross-sectional design to investigate differences in health between two groups of NH residents with dementia. One group lived in closed NHs (i.e., with closed unit doors) and the other group in semi-open NHs (i.e., with closed NH entrance doors). A total of 124 residents with dementia were recruited from five NHs in the Netherlands, of whom 61 residents lived in semi-open NHs and 63 residents lived in closed NHs. Data were collected using questionnaires to cover health dimensions according to the concept of Positive Health, including quality of life and participation, mental functioning and perception, daily functioning and bodily functions. An analysis of covariance, adjusted for age, gender and type of dementia, was used to examine differences in residents' health. Results: Most included residents had Alzheimer's or vascular dementia and 68% were female. No significant demographic differences were observed between the two groups in age, gender, type of dementia, length of stay, length of diagnoses and type of care package (p-values ranged from 0.097 to 0.606). After adjusting for multiple comparisons, there were no significant differences in any of the assessed health dimensions between residents of semi-open nursing homes and those of closed nursing homes, with a significance threshold of p <.004 accounting for the correction for multiple testing (p-values ranged from 0.020 to 0.870). Conclusions: This exploratory study found no significant differences in health between residents with dementia in semi-open and closed NHs. These findings contradict earlier research suggesting that more freedom of movement may enhance overall health in this population. Further research, preferably employing longitudinal designs, is necessary to establish causal pathways and identify the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: Being autonomous is important for people with dementia living in nursing homes. Our recent realist review indicated that supporting their autonomy depends on various aspects. Objective: This study aimed to uncover how people with dementia, their family members and care and treatment professionals experience the support of autonomy in daily care practice: what works, to what extent and under what circumstances. Design: A realist evaluation was performed using qualitative methods. Methods: We applied a realist approach through interviews with family members and care and treatment professionals, as well as on-site observations: due to their cognitive condition we could not exchange mutual views with residents directly. We performed these interviews and observations on site to find out how, to what extent and under what circumstances, supporting autonomy interventions work in daily practice situations. Causal assumptions were derived from the empirical data, leading to Context (C) –Mechanism (M) – Outcome (O) configurations. Results: Data extraction from 24 interviews and 8 observations resulted in 19 CMO configurations on four themes: A. Autonomy and boundaries: providing maximum autonomy influenced by safety and health restrictions. B. Organization of daily care processes: the influence of attempting to increase efficiency by working routines. C. Team competences and collaboration: the possibilities of care professionals to acquire the relevant competences and an appropriate level of team collaboration. D. Interaction and relationships: the accomplishment of a working relationship between residents, their family and care and treatment professionals. Conclusion: The results showed that supporting autonomy was valued highly by all stakeholders. In streamlining care processes, working routines were influential to supporting autonomy. Weighing risky choices for people with dementia in their decision making was another factor. Our study indicated that realizing autonomy is facilitated by a capable and collaborative team of professionals and by a working relationship between persons living with dementia, family members and professionals. [ABSTRACT FROM AUTHOR]

Objectives: Older adults with physical or cognitive disabilities may need to move to residential care facilities (RCFs). Some older adults smoke tobacco and become dependent on their care professionals to continue smoking. Care professionals need to balance an individual resident's quality of life and well-being with the health and safety of all residents and staff. Shared decision-making (SDM) could support care professionals in these dilemmas. This study assesses multiple factors that could affect care professionals' behavior and degree of SDM regarding residents' tobacco use., Design: We conducted quantitative cross-sectional research., Setting and Participants: We included care professionals working in psychogeriatric and somatic units in Dutch RCFs., Methods: Data were collected with an online or hard copy survey and analyzed with t-tests and regression analyses using SPSS., Results: Care professionals' positive attitudes toward residents' tobacco use are significantly associated with a lower degree of SDM concerning this use and enabling residents to smoke more often. The degree of SDM regarding residents' tobacco use is significantly positively associated with limiting residents' tobacco use and the degree of person-centered care (PCC). Care professionals working in somatic units report a significantly higher degree of SDM regarding residents' tobacco use compared with those working in psychogeriatric units., Conclusions and Implications: Residents' wish to smoke tobacco is a complex matter within RCFs. Care professionals' attitudes cause inconsistencies in their behavior and the degree of SDM. Moreover, care professionals tend to use SDM more often when they need to limit residents' use and cannot fulfill residents' unhealthy habits, such as smoking tobacco. SDM could support care professionals to deal with dilemmas regarding residents' tobacco use by including residents in decisions, regardless of the outcome. However, multiple factors affect care professionals' behavior and the degree of SDM. Especially, their attitudes need to be addressed. SDM is further complicated by national acts and organizational policies., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)