CHAPTER 7: CONCLUSION AND RECOMMENDATIONS
7.2 RECOMMENDATIONS
Based on the findings of the study, the following recommendations are offered:
7.2.1 Recommendations for consideration by the residential facility
• Residents should be encouraged to become involved in community activities, especially through volunteering, which have been found to have a beneficial effect on mental wellbeing mainly by boosting the individual’s sense of self- efficacy (Blazer, 2002; Keating et al., 2004; van Kemenade et al., 2006;
Veninga, 2006). Volunteering initiatives should be accompanied by support and by positive reinforcement of residents’ attempts to increase their sense of self-efficacy. It is also an avenue to increase network size and where through reciprocity a resource could be created for the access of practical help, which is a significant contributor to mental wellbeing.
• A participative forum should be initiated where residents can be involved in discussions and decisions bearing upon matters affecting the residence. The sense of agency engendered by this process could be emancipating and empowering (Boog, 2003; Keating et al., 2004) and productive of an increase in residents’ sense of self-efficacy.
• Increased frequency of contact/contact time between nursing staff and residents could lead to improved levels of trust between the two groups (Pettigrew & Tropp, 2006).
• That a number of residents were identified by the Kessler-6 as meeting the criteria for depression is cause for concern. It is recommended that annual screening of residents using a short tool such as the Kessler-6 be implemented.
• With an eye to promoting the use of technology, a peer leader should be identified amongst the residents as a resource person, ‘mandated’ to offer guidance in the advantageous use of the cellphone (Heinz et al., 2013) and the computer.
7.2.2 Areas where additional research is recommended
• Firstly, it is suggested that this study be replicated for older black persons who outnumber all other older persons combined, and whose number is expected to increase as life expectancy in general improves in South Africa in line with targets set by the National Development Plan 2030 (RSA, 2011). It may be anticipated that because so many older black persons, as members of ‘skip- generation’ families (Stats SA, 2010), have under their care so many younger persons, they will be more susceptible to high levels of psychosocial distress than were the residents who participated in this study (Lombard & Kruger, 2009). Consequently, if a repeat study involving older black persons were to be run, the Kessler-6 might need to be revalidated or replaced, in the light of the criticism this tool incurred following its use in the South African Stress and Health study (Andersen et al., 2011).
• There are opportunities for explorative studies. The first would have as its aim to clarify the reasons for the high level of emotional loneliness reported by the respondents of Indian descent who comprised a fifth of the sample. It is suggested that a narrative format be utilized as this will enable the residents of Indian descent to tell their story about their lived experiences as a racial and cultural minority in a setting where white older people formed a large majority. The information yielded by such an investigation will enable the facility management to better strategize a way forward in the expectation of a more balanced racial mix in the residence in the future (Lombard & Kruger,
2009; Pettigrew & Tropp 2006). Secondly, in the light of the finding that male residents exhibited higher levels of psychological distress than females, there is an opportunity to explore their experiences of moving into an environment that forced upon them a change of roles (diminished decision-making powers, diminished control over their lives) which probably dealt a severe blow to their sense of self-efficacy (Blazer, 2002; Drageset et al., 2011). The information obtained will enable integration processes into the residence to be more sensitively managed for both male newcomers and established male residents.
• Lastly this study has highlighted the relevance of further investigations relating to technologically assisted communication for the elderly. Interventions utilizing this technology should be introduced gradually, one device at a time being proposed to the elderly for their consideration, thus smoothing the path to acceptance (van Biljon & Renaud, 2009). The present study suggests that video chat ought to be introduced first, being the intervention best attuned to both the receptivity levels and the psychosocial needs of the residents. While phasing in this intervention, it will be possible - and necessary – to monitor the effectiveness of the different software options and also, on an individual basis, residents’ cognitive-processing capacities and the incidence of computer anxiety (Cody et al., 1999; van Biljon & Renaud, 2009). Any further investigation would seek to identify the best ways of training the direct-care staff in the use of whatever TAC device is mooted for introduction, and also the best ways of imparting their acquired skills to residents, in the knowledge that special difficulties of adaptability and dexterity accompany the learning process among the elderly (van Biljon & Renaud, 2009). Any TAC intervention involving direct-care personnel would need to be closely monitored as studies have shown that it is the quality of contact during the intervention, rather than the intervention as such, that makes the major difference, for good or ill, to mental wellbeing (Tsai, H-H. et al., 2010) which should, accordingly, be measured at regular intervals so as to track the psychological effectiveness of the intervention. The possibility of using tablets should be explored as they
sectional study, repeat study), which to a degree will depend upon the type of technology proposed for implementation, are discussed by various authors (Chung et al., 2010; Masi et al., 2011; Shapira et al., 2007; Tsai et al., 2010;
White et al., 2002; Wright, 2000)