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Effects of Psychosocial Interventions on Loneliness Amongst Long‐Term Care Residents: A Systematic Review and Meta‐Analysis

ABSTRACT

Background

Loneliness significantly affects the physical and mental health of older adults, particularly those in long-term care settings. Despite the high prevalence of loneliness, comprehensive reviews on psychosocial interventions targeting loneliness in these populations are scarce.

Aims

To evaluate the effects of psychosocial interventions in reducing loneliness among long-term care residents.

Study Design

A systematic review and meta-analysis.

Methods

We conducted a comprehensive search across five databases—CINAHL, EMBASE, PubMed/Medline, PsychINFO and The Cochrane Library—from inception to 14 February 2025. The inclusion criteria encompassed randomised controlled trials, quasi-experimental studies and pilot studies published in English that assessed psychosocial interventions for loneliness amongst long-term care residents. The Effective Public Health Practice Project framework was utilised for the quality assessment.

Results

A total of 19 studies with 1646 participants were included. Results indicated that psychosocial interventions significantly reduced loneliness in long-term care residents. The interventions were categorised into lifestyle and leisure activities, psychological interventions, social support interventions and animal/robot-assisted interventions. Subgroup analyses revealed significant effects for lifestyle and leisure activities, group-based interventions, face-to-face delivery and interventions that less than 8 weeks.

Conclusion

Psychosocial interventions demonstrated a large effect size in reducing loneliness amongst long-term care residents. Interventions that incorporated lifestyle and leisure activities with a physical activity component, delivered face-to-face in group settings and lasted for less than 8 weeks may be particularly effective.

Implication of Practice

This review provides updated evidence that psychosocial interventions could improve loneliness amongst residents in long-term care settings. Consequently, it offers solid information to inform policy changes and intervention strategies.

Reporting Method

The researching results were reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis checklist.

No Patient or Publication Contribution

This study is a systematic review with meta-analysis, and such details do not apply to our work.

Trial Registration: This protocol was registered in the PROSPERO database (ID: CRD42024534009)

Model Predicting Positive Aspects of Caregiving Among Family Cares of Persons With Dementia: A Longitudinal Cohort Study

ABSTRACT

Aim

Positive aspects of caregiving among family carers of persons living with dementia not only benefit the carers' health, but also enhance the quality and sustainability of invaluable informal care resources. To better inform the development of carer support intervention to optimise positive aspects of caregiving, this paper tested the integrative theoretical model based on stress coping and meaning-making paradigms.

Design

Longitudinal exploratory study.

Methods

From January 2018 to August 2021, 390 Chinese family carers of persons living with dementia were recruited from the geriatric clinics in Hong Kong. The criterion variable was measured by the Positive Aspect of Caregiving Scale at baseline and 6 months thereafter. The predictors were measured using the Dementia Management Strategies Scale, the Caregiving Self-Efficacy Scale, the Meaning-Focused Coping Scale, the Medical Outcome Study Social Support Survey, the Duke University Religion Index, the Positive Affect Index and the Intrinsic Motivations to Care. Path analysis tested the hypothesised model.

Results

The carers aged 56.2 (SD = 12.2); about two-thirds being female and adult-child caregivers. The hypothesised model showed an unsatisfactory model fit. The model was optimised by modification index with consideration of the theoretical plausibility in making the changes (CFI = 0.971, RMSEA = 0.057, SRMR = 0.027). After adjusting the baseline PAC, the 6-month PAC was predicted by self-efficacy in controlling upsetting thoughts and obtaining respite as well as meaning-focused coping. Various contextual factors strengthened the self-efficacy and meaning-focused coping, indirectly increasing PAC. Whereas carers' intrinsic motivation towards care and good dyadic relationships increased the carer's self-efficacy in emotional regulation, social support and religiosity played indispensable roles to facilitate meaning-focused coping.

Conclusion

PAC in dementia context is evolved from an integration of stress coping and existential meaning-making paradigms. Enhancing emotion and role regulation as well as meaning-focused coping are crucial to enhance the positive experience of the family carers.

Implications for the Profession and/or Patient Care

This project has generated a theory-driven and evidence-based predictive model to explain the manifestation of positive aspects of caregiving in dementia caregiving. The findings provide precise directions on how to empower family caregivers to create a fulfilling and meaningful caregiving adventure.

Impact

Substantial evidence indicates the role of positive aspects of caregiving in enhancing the carers' health outcomes in the context of dementia. However, inadequate theorization of this phenomenon delimits the momentum to develop proactive strategies to optimise such a positive caregiving experience. This longitudinal study indicated that positive aspects of caregiving are evolved from an integrative stress coping and existential meaning-making paradigm. More specifically, a sense of self-efficacy in emotional and role regulation as well as the use of meaning-making coping predict a higher level of positive aspects of caregiving. A context, which is characterised by high religiosity, good intrinsic motivation of care and a good dyadic relationship, also favours the cultivation of this positive experience during life adversity. This study facilitates a paradigm shift in supporting family carers in a dementia context and advances the theorization of positive human experience in facing life adversity.

Reporting Method

The reporting method complies with the STROBE, stands for observational study.

Patient or Public Contribution

Family carers of persons with dementia actively shared their experience in family caregiving.

Development of prison-based parent-child joint intervention for incarcerated fathers: protocol for mixed-methods study

Por: Yiu · W. Y. · Fung · Y. L. · Tsang · S. K. M. · Chan · C. H. Y. · Wong · P. W. C.
Introduction

Paternal incarceration represents a significant stressor that disrupts family cohesion, undermines paternal identity and adversely affects children’s psychosocial well-being. While family-focused programmes show promise in improving outcomes for incarcerated parents and their children, culturally attuned prison-based parenting interventions remain underdeveloped and scarce, particularly in Asian contexts. To address this gap, a local parenting intervention grounded in the Double ABCX model of family resilience, the ‘Be My Hero’ programme, was designed for incarcerated fathers in Hong Kong, China.

Methods and analysis

A concurrent mixed-methods design will be used to evaluate the intervention. A convenience sample of 20–30 incarcerated fathers of children aged 3–11 will be recruited from three correctional facilities. Quantitative measures assessing paternal competence, father–child attachment, communication and resilience will be collected preintervention and postintervention. Qualitative data will be triangulated through semistructured interviews with participants, their children and social workers, supplemented by session logs documenting perceived shifts in paternal identity and programme feasibility. The intervention is expected to mitigate disruptions in paternal identity and strengthen father–child bonds. This may, in turn, reduce intergenerational disadvantage and improve overall family well-being.

Ethics and dissemination

This study has received ethical approval from The University of Hong Kong. Informed consent and assent will be obtained from the participants, their children and current guardians. Findings will be disseminated through peer-reviewed journals or conferences to inform correctional rehabilitation practices, encouraging the integration of family-focused and resilience-based approaches. Stakeholders, including practitioners and policymakers, may adopt similar interventions to promote healthier re-entry outcomes and reduce intergenerational disadvantage.

Social Frailty in Heart Failure: Concept, Impact and Preventive Strategies

ABSTRACT

Aims

To explore the conceptualisation of social frailty and discuss its role in shaping the disease trajectory of heart failure. Based on the discussion, recommendations on how to prevent and manage social frailty in this clinical cohort are delineated.

Design

A discursive paper.

Methods

This paper searched two databases, PubMed and Google Scholar, for a narrative review of the literature related to social frailty and heart failure from 2008 to 2024.

Findings

By integrating the conceptualisation of social frailty from different theoretical paradigms, social frailty is a multi-domain construct that relies on a balance between the availability of environmental resources, social interactions and an individual's ability to maintain and acquire these resources to enhance their well-being. Substantial evidence showed the prognostic impact of social frailty on patient-reported, functional and clinical outcomes of patients with heart failure. The underlying mechanism is still under-investigated, but heart failure-related self-care may mediate its impact. Based on this evidence, improving social frailty may rely on a diagnostic protocol to enhance the person-centred care planning on ways to optimise the social resources to support complex self-care.

Conclusion

Social frailty poses a greater risk to health outcomes in patients with heart failure. Further research is needed to explore determinants and interventions for social frailty in this population.

Implications

This paper increases the awareness of social frailty in heart failure patients and provides important insights on how to combat this social determinant of poor health outcomes among this clinical cohort. A dual-purpose approach of improving social resources and self-care behaviours may have great promise in reducing their social frailty, and this postulation will need to be investigated in future research.

Patient or Public Contribution

There is no involvement of patients or the public in the design or writing of this discursive paper.

Measuring and monitoring safety of older adults living in retirement homes: a scoping review protocol

Por: Backman · C. · Engel · F. D. · Tonjock Kolle · A. · Papp · R. · Lam · A. · Freeman · L. · Li · W. · Sterling · E. · Fung · S. G. · Sinha · S. K. · Manis · D. R. · Wang · T.-F. · Kehoe MacLeod · K. · Hecimovich · C. · Webber · C. · Maskerine · C. · Syrowatka · A. · Fancott · C. · Kobewka · D
Background

The global population of older adults has grown at an unprecedented rate, and projections indicate that the number of older adults will continue to increase considerably in the coming decades. The clinical complexity of older adults living in retirement homes, also known as assisted living settings, is also increasing, and the regulations to ensure quality and safety standards in retirement homes are highly variable. The purpose of this scoping review is to map and summarise the methods used to monitor and measure the safety of older adults living in retirement homes, providing an overview of existing approaches and areas requiring further investigation.

Methods

This scoping review will follow the five stages of the Arksey and O’Malley scoping review process. We will report this review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A comprehensive search of four electronic databases (MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and Web of Science Core Collection) will be performed, and reference lists of included articles will be searched. We will conduct a two-step screening process, data extraction and analysis of the included studies. We will include all primary study designs that report on safety measurement and monitoring of any type of harms. Relevant grey literature will also be identified. We will exclude studies that only report results from facilities providing 24-hour skilled nursing care or specialised care services, and those not published in English or French. This protocol is registered on the Open Science Framework (osf.io/8rheq).

Ethics and dissemination

No ethical approval is needed for the review, and we plan to present the results at research conferences and in a peer-reviewed article. Our findings may inform future research studies that seek to support and improve safety practices in retirement homes.

How are different levels of social media engagement associated with mental distress and quality of life in young people living in deprived urban areas? A cross-sectional study in Bogota, Buenos Aires and Lima

Por: Lucchetti · S. · Brusco · L. I. · Diez-Canseco · F. · Gomez-Restrepo · C. · Olivar · N. · Flores · S. · Montes Guzman · L. · Fung · C. · Osorio Jaramillo · I. · Sanchez · H. · Stanislaus Sureshkumar · D. · Priebe · S.
Background

In deprived urban areas of South America, young people face heightened risks of mental disorders. Research suggests an association exists between social media engagement (SME), depression and anxiety.

Objective

This study explored the associations of SME with symptoms of depression, anxiety and subjective quality of life among young people from South American deprived urban areas.

Methods

Our cross-sectional survey study used an adapted version of the Multidimensional Facebook Intensity Scale to categorise 2399 participants into four SME groups: low, moderate, high and very high. Symptoms of depression (Patient Health Questionnaire-8), anxiety (Generalised Anxiety Disorder-7) and quality of life (Manchester Short Assessment) were assessed and compared using F and Tukey tests.

Findings

Each step of increased SME was associated with more symptoms of depression and anxiety and poorer quality of life. Statistically significant differences were observed across all groups (p

Conclusions

The findings suggest an association exists between SME, increased mental distress and lower quality of life in young people from deprived South American urban areas. This influence seems to apply across the spectrum of engagement levels, not only to extremes. However, due to the cross-sectional nature of the study, causal relationships cannot be established.

Implications

SME should be explored in clinical settings, as lower levels are associated with lower symptom levels and better quality of life. Policies addressing youth SME should be developed and evaluated in the challenging contexts of deprived urban areas.

Effectiveness of a centrally designed, large-scale, multisite undergraduate medical simulation programme: student-reported confidence across eight London hospitals in a UK medical school setting

Por: Fung · C. Y. · Wraith · C. · Houghton · N. · Woods · B. · Brown · C. · Dharmarajah · A. · Sam · A. H.
Objectives

Simulation is well established in medical education. However, with rising numbers of medical students globally, provision of high-quality, equitable simulation teaching on a large, multisite scale is increasingly challenging. We sought to explore whether a centrally designed, multisite simulation programme could enhance student confidence equitably across multiple clinical sites with differing resources.

Design

An evaluative study on the changes in medical student confidence on defined intended learning outcomes (ILOs) in 3 undergraduate year groups across 11 simulation sessions delivered at eight different clinical sites with variable resources and facilitators.

Setting

Eight hospitals affiliated with Imperial College School of Medicine.

Outcomes

Students’ self-reported confidence in achieving the ILOs via a questionnaire at the end of each session. Changes in confidence following each session were analysed and compared across sites.

Results

522 students responded to the survey over 3 academic years. Students’ mean confidence in achieving ILOs increased in all sessions. Nine out of 10 sessions showed no statistically significant difference in the confidence increases between sites.

Conclusion

Our study suggests it is possible to deliver an equitable, centrally designed, large-scale simulation teaching programme to medical students across multiple clinical sites with different facilitator teams. The programme is sustainable, easily facilitated by new teaching fellows each year and is likely adaptable to other healthcare professions and settings.

Feasibility and clinical and implementation effectiveness of an adapted early warning signs and symptoms intervention for the early detection of childhood cancer in Cameroon and Kenya: protocol for a quasi-experimental, hybrid type 2 implementation effect

Por: Noh · H. · Chelva · M. P. · Mbah Afungchwi · G. · Pondy · A. · Githanga · J. · Landis · F. · Kinge · M. · Martiniuk · A. L. · Ward · N. · Barwick · M. · Gupta · S. · Denburg · A.
Introduction

Childhood cancer accounts for a significant proportion of global childhood mortality, especially in low-income and middle-income countries (LMICs). Unlike many adult malignancies, primary prevention of childhood cancers is not possible. Improving survival requires a two-pronged strategy: earlier diagnosis and effective treatment. Our study aims to establish the feasibility, clinical and implementation effectiveness of an adapted early warning signs and symptoms (EWSS) intervention in Cameroon and Kenya. It will equip healthcare workers, Ministry of Health (MOH) representatives and National Cancer Institute leaders with evidence-informed guidance on implementing context-adapted interventions to improve the early detection and referral of childhood cancers in these countries.

Methods and analysis

The study is a quasi-experimental, hybrid type 2 implementation effectiveness study based on a Ghanaian adaptation of the ‘Saint Siluan’ EWSS campaign. Our protocol proposes context-specific adaptation and evidence-based implementation of the EWSS intervention through iterative engagement with country-level implementation teams to train healthcare workers and improve referral pathways for earlier childhood cancer diagnoses in each study country. Training effectiveness will be measured through pretraining and post-training tests of knowledge and application, as well as training satisfaction surveys. Clinical effectiveness will be assessed by using a REDCap database to track the number of newly diagnosed childhood cancer cases in the study regions and counties, healthcare timelines and paths to diagnosis, and the stage and proportion of metastatic disease at diagnosis. Implementation effectiveness will be evaluated through interviews with senior and mid-level health system partners and clinicians, tracking fidelity to the implementation process as laid out in The Implementation Roadmap Workbook, and analysis of meeting minutes from monthly local implementation team meetings.

Ethics and dissemination

This study has received ethical approval from The Hospital for Sick Children (REB # 1000080092) and all participating sites. We have received National Ethical Clearance from the Cameroon Ethical Board (#1699) and Regional Administrative Authorizations from our piloting regions (Centre and West). We have also received ethical clearance from Kenyatta National Hospital (KNH) (ERB# KNH-ERC/RR/955) and our National Commission for Science, Technology and Innovation in Kenya licence from the counties we are piloting in Kenya. As clinical data will be collected from existing health registries and patient charts, patient consent will not be required; however, we will obtain consent from all members of the leadership implementation teams and operational implementation teams for their participation in the implementation meetings and from all individuals participating in the semistructured interviews. We will disseminate findings to build awareness and share findings among various target audiences: (1) key county and regional parties (eg, clinical societies, advocacy groups, country MOHs and regional bodies such as the East African Community, Economic Community of West African States); (2) international bodies such as the WHO; and (3) the academic community.

Short-term effects of a virtual, community-based, task-oriented group exercise programme incorporating a healthcare-community partnership compared to a waitlist control on increasing everyday function among adults with mobility limitations: protocol for t

Por: Salbach · N. M. · Jones · C. A. · Barclay · R. · Sveistrup · H. · Sheehy · L. · Bayley · M. T. · Inness · E. L. · Legasto-Mulvale · J. M. · Barbosa dos Santos · R. · Fung · J. · Moineddin · R. · Teasell · R. W. · Catizzone · M. · Hovanec · N. · Cameron · J. I. · Munce · S. · ONeil · J.
Introduction

While group, task-oriented, community-based exercise programs (CBEPs) delivered in-person can increase exercise and social participation in people with mobility limitations, challenges with transportation, cost and human resources, threaten sustainability. A virtual delivery model may help overcome challenges with accessing and delivering in-person CBEPs. The study objective is to estimate the short-term effect of an 8-week, virtual, group, task-oriented CBEP called TIME™ (Together in Movement and Exercise) at Home compared with a waitlist control on improving everyday function in community-dwelling adults with mobility limitations.

Methods and analysis

A randomised controlled trial incorporating a type 1 effectiveness-implementation hybrid design is being conducted in four Canadian metropolitan centres. We aim to stratify 200 adults with self-reported mobility limitations by site, participation alone or with a partner, and functional mobility level, and randomise them using REDCap software to either TIME™ at Home or a waitlist control group. During TIME™ at Home classes (2 classes/week, 1.5 hours/class), two trained facilitators stream a 1-hour exercise video and facilitate social interaction prevideo and postvideo using Zoom. A registered healthcare professional at each site completes three e-visits to monitor and support implementation. Masked evaluators with physical therapy training evaluate participants and their caregivers at 0, 2 and 5 months using Zoom. The primary outcome is the change in everyday function from 0 to 2 months, measured using the physical scale of the Subjective Index of Physical and Social Outcome. The study is powered to detect an effect size of 0.4, given α=0.05, power=80% and a 15% attrition rate. Secondary outcomes are mobility, well-being, reliance on walking aids, caregiver assistance, caregiver mood, caregiver confidence in care-recipient balance and cost-effectiveness. A multimethod process evaluation is proposed to increase understanding of implementation fidelity, mechanisms of effect and contextual factors influencing the complex intervention. Qualitative data collection immediately postintervention involves interviewing approximately 16 participants and 4 caregivers from the experimental group, and 8 participants and 4 caregivers from the waitlist control group, and all healthcare professionals, and conducting focus groups with all facilitators to explore experiences during the intervention period. A directed content analysis will be undertaken to help explain the quantitative results.

Ethics and dissemination

TIME™ at Home has received ethics approval at all sites. Participants provide verbal informed consent. A data safety monitoring board is monitoring adverse events. We will disseminate findings through lay summaries, conference presentations, reports and journal articles.

Trial registration number

NCT06245135.

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