Nursing home residents and professional caregivers may engage in behaviors that, although not considered formal treatments for depression, can improve residents’ mood. To support future studies aiming to explore ways to complement formal depression care in nursing homes, reliable and valid instruments for measuring these informal mood-improving behaviors are needed. This project developed and evaluated inventories to measure mood-improving behaviors in Dutch and Belgian nursing homes. Study 1 followed an iterative mixed-methods approach to develop two inventories: the Actions to Improve Mood by Residents (AIM-R) and the Actions to Improve Mood by Caregivers (AIM-C), and to assess their content validity (N = 31 residents; N = 35 caregivers, respectively). Study 2 evaluated test-retest agreement (N = 206; N = 125) and inter-rater agreement (AIM-C: N = 81) using a test-retest design. Study 3 explored the inventories’ practical application through semi-structured interviews (N = 12; N = 6). Data were analyzed through thematic analysis, content validity indices, and Gwet’s AC2 agreement coefficients. Both inventories demonstrated acceptable content validity, with moderate to very good test-retest agreement. Inter-rater agreement for most AIM-C items was classified as “fair,” and appeared lower when caregivers completed the inventories for residents with moderate to severe cognitive decline compared to residents with no to mild cognitive decline. Thematic analysis suggested that using the inventories increased awareness of mood-improving behaviors and contributed to better knowledge about residents. Challenges regarding usability and interpretability were identified, along with suggestions for refinement. The inventories appear to adequately capture mood-improving behaviors and show consistency over time. Nevertheless, their usability and interpretability could benefit from further refinement. Pending additional research, these inventories hold promise for assessing mood-improving behaviors in nursing homes, aiding future efforts to explore new ways to enhance depression care alongside traditional treatments.

Background The Primary Care Functioning Consultation Tool (PCFCT) supports the integration of different aspects of health related functioning for patients with multimorbidity in disease management programs. Aim To assess feasibility, satisfaction, and potential effectiveness of the PCFCT on functioning, self-efficacy, illness perceptions, and disease performance indicators in daily general practice. Design & setting Pilot non-randomized controlled trial in Dutch general practices Method Patients with multimorbidity were allocated to the intervention group (consultations with the practice nurse using the consultation tool) or to the control group (regular consultations). Feasibility was assessed by recruitment, retention, and identified patients at baseline and 3 months. After 3 months, satisfaction of patients and nurses was measured. Potential treatment effects were assessed using the Primary Care Functioning Scale, Self-efficacy Questionnaire, Brief Illness Perception Questionnaire, and disease-related outcomes. Results Sixty-five patients were included (31 intervention, 34 control). Both patients and practice nurses reported high satisfaction and acceptability. Nineteen control patients (59%) and 24 intervention patients (80%) completed all questionnaires at baseline and 3 months. Between-group differences were not statistically significant, however intervention patients showed small exploratory differences towards better functioning, higher self-efficacy, and more adaptive illness perceptions. Missing data ranged from 25% to>90% across disease performance indicators, precluding reliable comparisons. Conclusion The PCFCT is feasible, acceptable, and can be embedded within existing chronic disease management, with the potential to improve patient outcomes.

BACKGROUND AND OBJECTIVE:This study examines interactions in residential care for people with dementia and severe challenging behaviour. Approaching dementia as contextualised, lived experience, it explores how meaningful encounters can be fostered for residents and those directly involved in their life and care. RESEARCH DESIGN AND METHODS:A phenomenological design informed by Todres' embodied enquiry was employed. Data were collected through intensive shadowing observations (35 hours) over a two-week period in a Dutch closed long-term care facility accommodating 16 residents. The daily work of 18 paid care workers was observed. RESULTS:Meaningful interaction emerged as a delicate balancing process, described as walking a tightrope, requiring continuous attunement to both pleasant and distressing dimensions of lived experience. Care workers fostered at-homeness, togetherness, and shared memories, while also acknowledging disorientation, loneliness, grief, and sadness. This balancing act unfolded across four interconnected dimensions: (1) at-homeness versus uncanniness in space, (2) togetherness versus loneliness in relationships, (3) continuous recalibration in embodied attunement, and (4) joy versus sorrow in personal narratives. DISCUSSION AND IMPLICATIONS:While previous research has emphasised the importance of connectedness for meaning in life, this study underscores another crucial perspective: genuine well-being requires sincere engagement with life's darker dimensions, not merely positive reassurance. Meaningful interaction depends on care workers' capacity to remain present with both affirming and unsettling aspects of life. This calls for a relational approach to care that acknowledges distress alongside positive experience, supports agency through doing-with, and employs inclusive, non-corrective communication practices that flexibly integrate clinical and humanistic perspectives.

Background Distress behaviour of people living with dementia is associated with negative effects for the person concerned, their family, and care staff. Video feedback interventions seem promising to use in nursing homes in cases of distress behaviour. In the Netherlands, a video feedback intervention “VIO” (Video Interventie Ouderenzorg) – in which the care team reflectively watches video footage, is asked stimulating questions by the VIO counsellor, and practises with assignments – can be used. This study aims to explain how VIO works, for whom, and under which circumstances. Methods A purposive sample of eight VIO counsellors and three care team members was interviewed in this realist interview study conducted in the Netherlands in 2022. The data was analysed by building Context-Mechanism-Outcome configurations. Results Participants reported that VIO can improve verbal and nonverbal communication with the person living with dementia and can work because team members become aware of their contribution to the interaction with that person and change their behaviour accordingly. According to the participants the impact of VIO can be determined by different factors, such as safety and trust within the care team, having a team member with an exemplary role, trust between the VIO counsellor and the care team, as well as by organisational conditions, such as the lack of staff, high sick leave, and managerial support. The role of family was rarely mentioned. Conclusions The design of VIO aligns with the way in which the care team learns. The intended outcomes of improved verbal and nonverbal communication and a decrease in distress behaviour are more likely to be achieved when team’s and organisational conditions, and the VIO counsellor’s approach are satisfactory. Future research should focus on testing and refining the discovered Context-Mechanism-Outcome configurations in practice. For daily practice, it is recommended to explore how to overcome incorrect expectations, and how to increase the role of family.

Abstract Background Increasing age as well as borderline personality pathology are associated with a lower level of health-related quality of life (HR-QoL). Our objective was to investigate whether the presence of borderline personality traits modifies the association between age and HR-QoL in the general population. Methods Cross-sectional data from 5,303 respondents (aged 21–72 years) of the Netherlands Mental Health Survey and Incidence Study-2 were analyzed. Borderline personality traits were assessed with the International Personality Disorder Examination questionnaire. Mental and physical HR-QoL were measured with the Medical Outcomes Study Short Form Health Survey. Multiple linear regression analysis was used to examine the association of borderline personality traits, age and their interaction on mental as well as physical HR-QoL, adjusted for demographic variables as well as somatic and mental disorders. Results A total of 1,520 (28.7%) respondents reported one or more borderline personality traits of which 58 (1.1%) reported five or more indicative of a borderline personality disorder. A higher age was associated with lower physical HR-QoL. This negative association became significantly stronger in the presence of borderline personality traits. The association between increasing age and mental HR-QoL was positive in the absence of borderline personality traits and negative in the presence of borderline personality traits. Conclusion Borderline personality traits negatively interfere with the association between age and HR-QoL irrespective of somatic and mental disorders. Attention of clinicians and researchers for subthreshold borderline personality pathology is needed in middle-aged and older persons.

Background: Depression is common among long term care (LTC) residents and has a considerable impact on their quality of life. Therefore, there has been an increased interest in interventions aiming at the reduction of depression among LTC residents. These interventions could be described as formal depression care and include psychosocial interventions (e.g., Creative Arts Interventions), psychotherapeutic interventions (e.g., Life Review) and/or (neuro-)biological interventions (e.g., psychopharmacotherapy). Previous research on the effectiveness of formal depression care suggests that treatments should be more individually tailored. Tailoring treatments, however, is a time- consuming process which may hinder the implementation in LTC. A more integrative approach targeting specific groups of nursing home residents is therefore preferred and may benefit both residents and staff. To do so, insight in moderator effects is needed to better understand and better match treatments to specific groups of LTC residents. Objectives: The aim of this study is to provide insight into (1) the effectiveness of interventions, (2) the influence of residents’ characteristics (e.g., residents with cognitive impairment versus residents with physical disabilities) and/or (3) the influence of contextual factors (e.g., group-based versus individual therapy) which may have an impact on the effectiveness of interventions. Eligibility criteria: Various databases (e.g., EBSCO, PubMed, COHRANE Library) are searched using a predefined search string, combining terms concerning our PICO elements (e.g., “Nursing Home Residents” (P), “Treatment” (I), “Depression” (O)). We only include a) randomized controlled trials investigating the use of formal depression treatments (independent variable), b) among LTC residents and, c) having used a standardized measurement tool for, d) depression (dependent variable). Results of this systematic search will be presented. Method of synthesis: Eligible studies will further be screened and assessed for residents’ characteristics and/or contextual factors. A random-effects model will be used to calculate the pooled standardized mean difference (SMD) and to assess the strength of the effects of formal depression treatments on depression. Further subgroup-analysis and meta-regressions will be used to assess the potential moderator effects. Conclusion: To better match treatments to LTC residents, more insight into the effectiveness, moderator effects and core components of the applied interventions is needed.

Background: Although formal treatments like antidepressants and psychotherapy may effectively reduce depression in nursing home residents, side effects and poor treatment adherence are common. To improve depression care, it is important to also learn from informal strategies already used successfully in daily practice, alongside or in absence of formal treatment. For example, although not prescribed as formal treatment, a care provider may seat a resident with depression at a table near the window. This may have antidepressant effects due to extra day light or pleasant views from the window. Objectives: To identify, categorize, and prioritize informal antidepressant strategies for residents already used in daily practice as reported by residents themselves, their relatives, and professional caregivers. Method: In the first Group Concept Mapping study, residents, relatives, and professional caregivers (N = 124) brainstormed on strategies to prevent or improve depression that may be performed by residents themselves. In the second study, the same participants (N = 110) reported on strategies others involved in residents’ lives could perform. In a second round of both studies, participants rated the expected effectiveness (N = 54, N = 51 respectively) and feasibility (N = 50 for both studies) of the strategies mentioned. In addition, strategies for both studies were sorted based on similarity in meaning by experts. Results: Six clusters appeared for actions to be undertaken by residents themselves, and five clusters for actions by others. The results showed that, for strategies by residents, the clusters ‘Being socially connected’ and ‘Participating in activities’, and for strategies by others, the cluster ‘Offering personal attention’ stand out the most in terms of high expected effectiveness. The cluster with strategies executed by residents that stood out as the most feasible was ‘Having a healthy living environment’. The most feasible clusters performed by others were ‘Offering personal attention’, ‘Using positive treatment/approach’, and ‘Using or adapting the physical environment’. Conclusion: By using an innovative bottom-up participatory approach, this research shed light on various clusters of useful informal antidepressant strategies for daily practice. To test effectiveness and implementation, research is needed on these antidepressant strategies and their regular use in care.

Background: Western countries face an aging population and increasing number of people with chronic illnesses. Many countries have shifted from a focus on institutional care to home-based care due to growing healthcare costs and pressure on long-term care. Despite, the increasing difficulty for contemporary family structures to support community-dwelling older adults (CDOA) who need care. However, about 50% of households own pets which may provide some social support for CDOA. A dearth of studies investigated the support pets provide to CDOA that receive long-term care but a better understanding of pets’ support in CDOA is needed to help develop healthcare protocols and interventions that account for pets in CDOA’s lives. Research Objective: To add insight into pets’ roles in support systems and the meaning this has for CDOA. Method: This integrative review was based on qualitative studies on CDOA with pets (average age 65+). Due to few studies on CDOA with pets with chronic illnesses, this review also includes CDOA without a chronic disease. PubMed and PsycINFO, were searched with (MeSH) variations on terms of older adults, pets, and qualitative study-designs. Additionally, reference lists of systematic reviews and HABRI Central were searched. The included articles were inductively analysed in ATLAS.ti. Results: A total of 15 articles were included in the review. 28 subthemes were categorised in 7 bidirectional factors: social, care, physical health, emotional, cognitive, bonding, and behavioural. CDOA indicate that pets are very important in their lives and have a positive influence on their social environment, mental, and physical health. However, also negative aspects of pet ownership were discussed. Limitations of the review were the varying research questions and diversity of participants in the included studies. Furthermore, we identified a need in some CDOA to keep their pets as long as possible. Conclusion: This review adds a more comprehensive view on the meaning and role of pets in providing support to CDOA. However, more research is needed into the effects of the revealed factors on the wellbeing of CDOA and healthcare organisations should consider the development of guidelines accounting for the pets of long-term care clients.

Measuring quality of life is a necessity for adequate interventions. This paper concerns the usefulness of six self-report measures for overall quality of life for nursing home residents with various levels of cognitive impairment. It was investigated which proportion of residents from four cognition groups could complete a scale, and internal consistency and construct validity of the scales were studied. Data collection took place in ten Dutch nursing homes (N = 227). The proportion of residents that could complete each scale varied. The Depression List could be administered most often to the cognitively most impaired group (43%; Mini Mental State Examinationscores 0–4). In the three cognition groups with MMSEscore >5, internal consistency of the Depression List, Geriatric Depression Scale and Negative Affect Scale was adequate in all three groups (alpha ‡.68). Intercorrelation was highest for the Philadelphia Geriatric Center Morale Scale, the Depression List, and the Geriatric Depression Scale (rho ‡.65). Nonetheless, self-report scales were not strongly correlated with two observational scales for depression, especially in cognitively severely impaired residents (rho £ .30). In conclusion, it may not be possible to measure overall quality of life through self-report, and possibly also through observation, in many nursing home residents.

This cross-sectional study investigated the relationship between apathy and quality of life (QOL) in nursing home residents (n = 227). In all, 92 residents could be assessed with the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS) and the Philadelphia Geriatric Centre Morale Scale (PGCMS), and were able to answer a question about overall subjective QOL. Apathetic behaviour and consciousness disorders were measured with the Behaviour Rating Scale for Psychogeriatric Inpatients (GIP). Linear regression analysis was first applied to study the association of cognition, depression and consciousness with apathy. It was then used to study the relationship between apathy and QOL, controlling for the constructs that were associated with apathy. The relationship between apathy and QOL appeared to vary with the cognitive functioning of the residents: In residents with a low level of cognitive functioning, apathetic behaviour was associated with high QOL; in residents with a higher level of cognitive functioning, apathetic behaviour was associated with low QOL. The necessity and nature of interventions aimed at stimulating apathetic residents may depend on the level of cognitive functioning of the residents. Further research is needed to determine if and when apathy interventions are appropriate.

We investigated whether adults with a parent with dementia experience their personal aging differently than adults whose parents do not have dementia. Semi-structured interviews were conducted with 25 adults who had a parent with dementia and 25 controls. We found that, although in a general sense the two groups were quite similar in their personal experiences of aging, there were specific differences. The children of parents with dementia had a health-concept in which there was substantial emphasis on mental health. Moreover, they linked the dementia of their parent to their own aging and worried about developing a dementia syndrome themselves. They also held different attitudes with regard to end-of-life decisions. Finally, participants having a parent with dementia gave more extensive answers to simple questions. This overall response suggests more involvement with growing older and finitude in the children of parents with dementia.