Problems identified by dual sensory impaired older adults in long-term care when using a self-management program: A qualitative study.
OBJECTIVE
To gain insights into the problems of dual sensory impaired older adults in long-term care. Insights into these problems are essential for developing adequate policies which address the needs of the increasing population of dual sensory impaired older adults in long-term care.


METHODS
A qualitative study was conducted in parallel with a cluster randomized controlled trial. Dual sensory impaired older adults in the intervention group (n = 47, age range 82-98) were invited by a familiar nurse to identify the problems they wanted to address. Data were taken from the semi-structured intervention diaries in which nurses noted the older adults' verbal responses during a five-month intervention period in 17 long-term care homes across the Netherlands. The data were analyzed using descriptive statistics and qualitative content analysis based on the Grounded Theory.


RESULTS
The 47 dual sensory impaired older adults identified a total of 122 problems. Qualitative content analysis showed that the older adults encountered participation problems and problems controlling what happens in their personal environment. Three categories of participation problems emerged: (1) existential concerns of not belonging or not being able to connect with other people, (2) lack of access to communication, information and mobility, and (3) the desire to be actively involved in care delivery. Two categories of control-in-personal-space problems emerged: (1) lack of control of their own physical belongings, and (2) lack of control regarding the behavior of nurses providing daily care in their personal environment.


CONCLUSIONS
The invasive problems identified indicate that dual sensory impaired older adults experience great existential pressures on their lives. Long-term care providers need to develop and implement policies that identify and address these problems, and be aware of adverse consequences of usual care, in order to improve dual sensory impaired residents' autonomy and quality of life.
Donders Institute for Cognition, Brain and Behaviour, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.|Kalorama Foundation, Beek-Ubbergen, The Netherlands.
Lieve
http://orcid.org/0000-0002-7248-7968
L
Roets-Merken
Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Sytse
S
Zuidema
Donders Institute for Cognition, Brain and Behaviour, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Myrra
M
Vernooij-Dassen
IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Marianne
M
Dees
Severinus Foundation, Veldhoven, The Netherlands.
Pieter
P
Hermsen
Department of Health Services Research, CAPHRI School for Public Health and Primary Care Maastricht University, Maastricht, The Netherlands.
Gertrudis
G
Kempen
Donders Institute for Cognition, Brain and Behaviour, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.|IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Maud
M
Graff
D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D006282:Health Personnel; D034381:Hearing Loss / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007398:Interpersonal Relations; D008134:Long-Term Care / Q000523:psychology*; D008297:Male; D009426:Netherlands; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology*; D014786:Vision Disorders / Q000150:complications* / Q000523:psychology / Q000628:therapy*