Review
Resident outcomes of person-centered care in long-term care: A narrative review of interventional research

https://doi.org/10.1016/j.ijnurstu.2014.04.003Get rights and content

Abstract

Background

Person-centered care has been widely promoted in long-term care settings. It is commonly referred to as a core concept that guides the care philosophy change in long-term care settings from a traditional medical model to a more humanistic approach to care. Current person-centered practice in long-term care settings is guided by multiple person-centered care models. However, evidence regarding the effects of person-centered practice guided by multiple models on residents’ outcomes has not been well established or synthesized.

Objectives

To outline and compare the principal models and to synthesize current evidence of the effects of multiple person-centered care models on resident outcomes.

Method

Systematic searches were conducted using CINAHL, MEDLINE, PsychoINFO, Evidence Based Medicine Reviews, Cochrane Review databases, and ProQuest Dissertations and Theses using the following keywords (UK and US spellings) individually and in multiple combinations: person-centered care, resident-centered care, client-centered care, individualized care, patient-centered care, culture change, Eden Alternative, Wellspring, Green House, Pioneer Network, dementia, nursing home, assisted living and long-term care. The searches were limited to articles written in English and published from January 1990 to April 2013. Then a manual search of the reference lists of selected relevant articles was conducted.

Results

Twenty-four studies from three countries were reviewed and compared in terms of person-centered interventions, measurement, and resident outcomes. 15 culture change studies for residents who were cognitively intact or with minor cognitive impairment and 9 studies for residents with dementia were reviewed. Across the studies, culture change models had some beneficial effects on residents’ psychological wellbeing. Person-centered dementia care had significant effects on decreasing behavioral symptoms and psychotropic medication use in dementia residents in long-term care.

Conclusion

An agreed upon definition of person-centered care is essential for researchers and clinicians to guide person-centered care development and implementation. Rigorous study design and objective and subjective measurement use are needed for future studies, especially those guided by culture change models. The effectiveness of person-centered care on residents’ bio-psycho-social outcomes like sleep, stress, and physical wellbeing need to be addressed and systematically examined with subjective and objective measures in future studies.

Section snippets

Background

The demand for long-term care (LTC) services has risen with the growing aged population. However, residents’ lives in LTC have been characterized by loneliness, helplessness, and boredom (Thomas, 1996). LTC includes skilled nursing homes, assisted living, and other types of residential or care homes where residents live on the premises. LTC residents are reported to have lower quality of life and poorer outcomes than community dwelling elders, including increased depressive symptoms, rapid

Search strategy

Two search strategies were used to identify relevant articles for this narrative review. First, multiple databases were searched and relevant articles were selected. Second, reference lists of all articles selected were reviewed to identify additional relevant articles.

Searches were conducted on CINAHL, MEDLINE, PsychoINFO, Evidence Based Medicine Reviews, Cochrane Review, and ProQuest Dissertations and Theses using the following keywords individually and in multiple combinations:

Results

The studies were categorized into two groups based on the type of PCC intervention. The first group includes studies for LTC residents in general (Table 1). All 15 studies in this group were guided by culture change models and conducted in the US. The second group, conducted in the UK, Australia, and US, includes studies specifically for residents with dementia; most studies (8 out of 9) in this group reflected Kitwood's PCDC model (Table 2).

Discussion

Person-centered care, which is viewed as a high quality approach in residential care settings, requires a significant shift in philosophy from custodial, physical task-oriented care to care that redirects the control to residents with the goal of facilitating autonomy, independence, and QoL. It is a care model that upholds the older adults’ humanity and works on the unique needs of the individual rather than institutional and biomedical goals (Brooker, 2007, Gladman et al., 2007, Powers, 2005).

Conclusion

There are several ongoing efforts to improve the quality of life and care in LTC settings across the world, as alluded to in our introduction. None have the kind of strong empirical evidence base that we need or would like, but all have at their heart the desire to make things better. It is unlikely that any of these models, in isolation can have a lasting impact and there is a need to conduct further synthesis and investigate the accumulative impact of combining approaches and models. The

Conflict of interest

None declared.

References (59)

  • D. Brooker

    Dementia Care Mapping. Principles and Practice of Geriatric Psychiatry

    (2010)
  • California Healthcare Foundation

    Rethinking the Nursing Home: Culture Change Makes Headway in California. Oakland, CA

    (2008)
  • L. Camberg et al.

    Evaluation of simulated presence: a personalized approach to enhance well-being in persons with Alzheimer's disease

    J. Am. Geriatr. Soc.

    (1999)
  • S. Caspar et al.

    The differential influence of culture change models on long-term care staff empowerment and provision of individualized care

    Can. J. Aging

    (2009)
  • J. Cohen-Mansfield et al.

    Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention

    J. Gerontol. Ser. A: Biol. Sci. Med. Sci.

    (2007)
  • M.T. Coleman et al.

    The Eden Alternative: findings after 1 year of implementation

    J. Gerontol. Ser. A – Biol. Sci. Med. Sci.

    (2002)
  • W.H. Cushman et al.

    Human factors in product design

    Adv. Hum. Factors/Ergon.

    (1991)
  • J. Dewing

    Concerns relating to the application of frameworks to promote person-centredness in nursing with older people

    J. Clin. Nurs.

    (2004)
  • J. Fossey et al.

    Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial

    Br. Med. J. (Int. Ed.)

    (2006)
  • J.R. Gladman et al.

    Person-centred dementia services are feasible, but can they be sustained?

    Age Ageing

    (2007)
  • L.A. Grant et al.

    Culture change in a for-profit nursing home chain: an evaluation

    (2008)
  • W.J. Herrmann et al.

    Nursing home residents’ self-perceived resources for good sleep

    Scand. J. Prim. Health Care

    (2011)
  • N.L. Hill et al.

    Culture change models and resident health outcomes in long-term care

    J. Nurs. Sch.

    (2011)
  • M.R. Hinman et al.

    Influence of the EDEN ALTERNATIVE on the functional status of nursing home residents

    Phys. Occup. Ther. Geriatr.

    (2002)
  • C.S. Jones

    Culture Change and Quality of Life in Elderly Persons Living in Long Term Care

    (2010)
  • R.L. Kane et al.

    The effect of Evercare on hospital use

    J. Am. Geriatr. Soc.

    (2003)
  • R.A. Kane et al.

    Resident outcomes in small-house nursing homes: a longitudinal evaluation of the initial green house program

    J. Am. Geriatr. Soc.

    (2007)
  • H. Kirvesoja

    Experimental ergonomic evaluation with user trials: EEE product development procedures

    (2001)
  • T. Kitwood

    Dementia reconsidered: The person comes first

    Adult Lives: A Life Course Perspective

    (1997)
  • Cited by (127)

    • The delivery of intergenerational programmes in the nursing home setting and impact on adolescents and older adults: A mixed studies systematic review

      2022, International Journal of Nursing Studies
      Citation Excerpt :

      Research into the effects of intergenerational programmes continues to identify favourable outcomes for young children (positive attitudes, behaviours, confidence, competence, and improved mental and physical health), and improved quality of life for older adults (Giraudeau and Bailly, 2019) including improved social connectedness, wellbeing, and wellness (Peters et al., 2021; Rosenwohl-Mack et al., 2020). Moreover, intergenerational relationships are supportive of mutually beneficial social growth (Radford et al., 2019) and aim to enhance the delivery of person-centred care in a nursing home setting for older adults (Li and Porock, 2014). However, little is known about the design and delivery of intergenerational programmes involving adolescents and older adults within the nursing home setting and the impact that these programmes have on those engaged.

    • Voices of long-term care workers: Elder care in the time of COVID-19 and beyond

      2024, Voices of Long-Term Care Workers: Elder Care in the Time of COVID-19 and Beyond
    View all citing articles on Scopus
    View full text