Abstract
Background: Healthy ageing has been defined by the World Health Organization as a process, which supports the well-being of older persons by maintaining and improving their functional capacity. To offer older persons the care required to maintain a level of functional ability that is consistent with their basic rights, personal preferences, fundamental freedoms, and human dignity, high-quality long-term care is crucial. It is currently an important societal issue whether care home residents receive the necessary and dignified care. Most older persons in care homes have poor health, with
impaired physical and/or cognitive functioning, and many live with severe cognitive impairment. Thriving describes the experience of well-being in relation to the environment, focusing on contentment with one’s situation from a phenomenological life-world perspective. To measure older persons’ thriving in care homes, Bergland et al. (2014, 2015) developed The Thriving of Older People Assessment Scale (TOPAS) instrument. To ensure high-quality aged care and a good life for older persons in care homes, scientific research is needed to investigate factors that can affect their thriving. Since the beginning of the 2000's, thriving has been the topic of several studies in
Norway and Sweden, but it has previously not been studied in Finland.
Aim: The overarching aim of this thesis was to explore older persons’ experience of thriving in care homes and to gain new knowledge about factors influencing thriving.
Design: The design of this thesis began with a scoping review on the state of knowledge concerning promotion of thriving among older persons in care homes and the factors that influence their experience of thriving (Study I), followed by two quantitative studies concerning their experience of thriving, its associations with demographic factors and central interRAI scale factors (Study II), and the interrater agreement between resident and proxy assessments of thriving (Study III).
Methods: Study I is a scoping review on thriving based on the methodological framework by Arksey and O’Malley (2005) and presented following the PAGER (Patterns, Advances, Gaps, Evidence for Practice, and Research recommendations) framework (Bradbury-Jones, 2022). In Study II, the thriving of the residents in four public care homes was measured by staff using the short-form TOPAS (Baxter et al., 2019) in a cross-sectional survey, including also the interRAI assessment. Descriptive statistics and logistic regression analyses were performed. In Study III, the interrater agreement
concerning thriving between resident-self and proxy assessments obtained from relatives and staff was measured using Cohen’s weighted kappa calculations. The reporting was guided by the STROBE checklist in Studies II and III.
Results: In Study I, five factors contributing to thriving were recognized: resident’s attitude towards living in care homes, quality of care and caregivers, activities and interactions with others, qualities of the physical environment, and health. Two studies reporting interventions were identified in Study I. In Study II, resident thriving as assessed by staff was relatively high. The interRAI scale factor of social engagement showed the strongest association with thriving, followed by female gender (Study II). The interrater agreement levels concerning thriving between residents and staff were generally higher than those between residents and relatives or between relatives and staff (Study III).
Conclusion: The scoping review of Study I highlights the scarcity of knowledge about older persons’ thriving in care homes. The review results could contribute to our understanding of the factors involved and interventions needed to improve thriving (Study I). More attention should be focused on social engagement for the residents in care homes and on the male residents’ experience of thriving (Study II). Most residents in care homes for older persons have cognitive impairment. They have the right to express what is best for them, but proxy assessments are needed to make their voices heard. Relatives should be given an opportunity to adopt a greater role in aged care,
and the co-operation and communication between relatives and staff concerning residents’ everyday life should be improved (Study III).
impaired physical and/or cognitive functioning, and many live with severe cognitive impairment. Thriving describes the experience of well-being in relation to the environment, focusing on contentment with one’s situation from a phenomenological life-world perspective. To measure older persons’ thriving in care homes, Bergland et al. (2014, 2015) developed The Thriving of Older People Assessment Scale (TOPAS) instrument. To ensure high-quality aged care and a good life for older persons in care homes, scientific research is needed to investigate factors that can affect their thriving. Since the beginning of the 2000's, thriving has been the topic of several studies in
Norway and Sweden, but it has previously not been studied in Finland.
Aim: The overarching aim of this thesis was to explore older persons’ experience of thriving in care homes and to gain new knowledge about factors influencing thriving.
Design: The design of this thesis began with a scoping review on the state of knowledge concerning promotion of thriving among older persons in care homes and the factors that influence their experience of thriving (Study I), followed by two quantitative studies concerning their experience of thriving, its associations with demographic factors and central interRAI scale factors (Study II), and the interrater agreement between resident and proxy assessments of thriving (Study III).
Methods: Study I is a scoping review on thriving based on the methodological framework by Arksey and O’Malley (2005) and presented following the PAGER (Patterns, Advances, Gaps, Evidence for Practice, and Research recommendations) framework (Bradbury-Jones, 2022). In Study II, the thriving of the residents in four public care homes was measured by staff using the short-form TOPAS (Baxter et al., 2019) in a cross-sectional survey, including also the interRAI assessment. Descriptive statistics and logistic regression analyses were performed. In Study III, the interrater agreement
concerning thriving between resident-self and proxy assessments obtained from relatives and staff was measured using Cohen’s weighted kappa calculations. The reporting was guided by the STROBE checklist in Studies II and III.
Results: In Study I, five factors contributing to thriving were recognized: resident’s attitude towards living in care homes, quality of care and caregivers, activities and interactions with others, qualities of the physical environment, and health. Two studies reporting interventions were identified in Study I. In Study II, resident thriving as assessed by staff was relatively high. The interRAI scale factor of social engagement showed the strongest association with thriving, followed by female gender (Study II). The interrater agreement levels concerning thriving between residents and staff were generally higher than those between residents and relatives or between relatives and staff (Study III).
Conclusion: The scoping review of Study I highlights the scarcity of knowledge about older persons’ thriving in care homes. The review results could contribute to our understanding of the factors involved and interventions needed to improve thriving (Study I). More attention should be focused on social engagement for the residents in care homes and on the male residents’ experience of thriving (Study II). Most residents in care homes for older persons have cognitive impairment. They have the right to express what is best for them, but proxy assessments are needed to make their voices heard. Relatives should be given an opportunity to adopt a greater role in aged care,
and the co-operation and communication between relatives and staff concerning residents’ everyday life should be improved (Study III).
| Original language | English |
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| Place of Publication | Åbo |
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| Print ISBNs | 978-952-12-4616-6 |
| Electronic ISBNs | 978-952-12-4617-3 |
| Publication status | Published - 2025 |
| MoE publication type | G5 Doctoral dissertation (article) |