Incorporating Having a Purpose in Life into Nursing Homes to Improve Resident’s Health

Need/Purpose for the study

The aging population in the United States is growing and it is becoming a health challenge. For the first time in history people older than 65 are expected to outnumber children under the age of 5 years old. In 2016 there were 15,600 nursing homes in the U.S. and 1.7 million licensed beds [1,2]. Traditionally, care in nursing homes have been based on a hospital model which leads to seniors being treated like patients rather than residents Kiyota [3]. This model points out the challenges that nursing homes can face to provide a more wholistic care. As we age, it is important to still find meaning and purpose in life. It can be hard to foster this feeling as we age because many people have already fulfilled life-long goals Cocarla [4]. This can be even more challenging for seniors in a nursing home because as stated before, they can sometimes be treated as a patient and not a resident. Therefore, it is important to analyze how we can improve nursing homes to include ways to facilitate a purpose in life. These changes can affect the residents mentally and physically. Studies have shown that having a purpose can lead to a decreased risk in having a stroke and a decreased risk in dying from cardiovascular disease Koizumi et al. [5]. Hence, it is vital that nursing homes use this research to guide their care and find solutions to improve their resident’s outcomes.

Context/History of the project

Humans naturally want to have a purpose in life and will spend their time finding this purpose. Philosophy has looked into the meaning of life and if people give life meaning or if meaning gives people life. These bring up the subjective and objective meaning in life. The objective meaning is that the world is giving us direction and a sense of purpose. The subjective meaning is that the person searches for things that help achieve their goals, projects, and actions which then gives them a meaning to life. Both of these meanings can be used to better understand why we need a purpose in life and how having that purpose can improve health. Having this purpose can be harder to achieve as we age. The aging population is growing in the United States, and the U.S. Census Bureau predicts that by 2060 we will have a pillar shaped population model, as compared to the pyramid population model in 1960 [6]. This is because of advancements in medicine and technology. These advancements have helped increase the life expectancy. With this type of change in the population model, the healthcare system will (and already is) seeing challenges that must be overcome.
In 2010, the majority of older adults (93.5% or 33.4 million) were living in the community, while only about 4.5% or about 1.5 million were living in nursing homes. Even though less seniors live in nursing homes, they face unique challenges to their care. For example, most nursing home residents require some level care with daily activities such as preparing meals, bathing and dressing, managing medications, and mobility (Facts and Statistics About U.S. Nursing Homes). Since nursing homes do provide round the clock care, they can be costly. In 2018, the average price for a private room in a nursing home was $8,300 [7]. While this may seem like nursing homes are making a large profit on this, many nursing homes face financial pressure because they are functioning on thin margins and do not receive adequate Medicaid reimbursement Health Stream [8]. Nursing homes also face a staffing shortage which can increase the risk of rehospitalization Health Stream [8]. Additionally, nursing homes are trying to create individualized care for their patients, but unsupportive management can create barriers Suhonen et al. [9]. Having adequate nursing staff and nurses who are motivated, still requires effective leadership to help manage and implement individualized nursing care [10]. These barriers that nursing homes face, impact the patients care so it is important to find solutions to improve care. One solution is utilizing volunteers to help with the “non-medical” type of care. This could include activities that help provide a purpose in their life, such as picking up a new hobby or engaging within the community. There are many ways that seniors can look for a purpose in this stage if their life. These include, practicing mindfulness, exploring nature, and doing creative tasks Cocarla [4]. According to the Center for Disease Control in 2010, 33% of assisted living facilities in the U.S. use volunteers to help the residents or the staff (Senior Care). Having more nursing homes use volunteers could help alleviate some of the stress the staff is already experiencing and would provide a unique outlet to allow the seniors to connect with the community.

The purpose of this study is to analyze why having a purpose in life is important as we age, and how we can use this research to guide improvements in care at U.S. nursing homes.

This report is based on research found using the USF library online database. The research was started with the intention of learning about how having a purpose in life affects seniors. As research progressed it was clear that having a purpose affects physical and mental health and should be included in all older adult’s lives. Since the focus was on the older population, it was important to look at what types of environments they live in and how they can be assisted. Doing research from the CDC and the U.S. Census Bureau provided general statistics on the aging population. Going back to the USF database, articles were found that talked about nursing home care and how that population faces unique challenges. It was then decided that the analysis on having a purpose in life could be used to propose solutions to improve care in nursing homes. Once articles were found that provided both background information and case studies, their reference was used to find even more background information. This is because it was important to understand what barriers nursing homes face and how solutions can be used to fit around the barriers. Lastly, Google Scholar was used to find more general information on having a purpose in life. One article in Time magazine provided a review on some research relating to this topic. Using that article, the original source was found and the references from that source helped complete the search of sources. Overall, the sources used a variety of methods including self-surveys, case studies, prospective cohort studies, and longitudinal cohort studies. Having a variety of methods is important because each method has pros and cons that when put together can create a very compelling argument.

This study focuses on applying having a purpose in life in a nursing home setting. While it is assumed that the suggested ways to enhance the seniors experience in a nursing home would also enhance those not living in a nursing home, more research would be needed to draw this conclusion. Additionally, the analysis on how having a purpose in life is based on several studies that were self-reported. These provide valuable information but do naturally have a bias. However, the study by Eric Kim and colleagues used objective data and recorded measurements on the physical health of the patients. They were able to show an association between having a purpose in life and improved physical health Kim et al. [10]. Therefore, their findings of having a sense of purpose in life being associated with improved physical health were more reliable. These results should try to be replicated in other studies to provide even more evidence and form a solid objective platform for this research. Additionally, some of the solution ideas provided in this paper may not be financially feasible for all nursing homes, but other alternatives are provided. Lastly, this paper is using multiple research reports to propose solutions, but it could be beneficial to interview/ speak with current nursing home residents to see what they would want. For example, a nursing home could survey their patients to see what types of activities they have liked in the past and which ones they would like to see in the future.

The older we get the harder it can be to feel like we are important and that our life has purpose. In younger years it is common to have goals of the future, but as we get older the goals change to be more present oriented and we develop goals around deepening personal relationships Bühler [1]. Studies have shown that having a purpose in life can improve physical health in the elderly. These physical benefits can be implemented in places like nursing homes to increase overall patient care. Such solutions include facilitating activities that stimulate creativity, help the patients change up their daily routine, and providing engagement with the community. These solutions could be implemented in some nursing homes by hiring all-purpose staff to help engage with the residents and maintain/facilitate activities. However, currently U.S. nursing homes face many challenges including financial stress and understaffing of nurses, but there are solutions around these as well. For instance, partnering with volunteer groups or local schools to have volunteers fulfil the all-purpose staff role could be an option for nursing homes with less financial means. Overall, there is more to nursing home care than traditional medicine and using studies about having a purpose in life to guide possible solutions, we can improve overall care and patient outcomes in nursing homes.

Having a purpose as we age

As we age, we look forward to retirement and the extra time we hope it will bring. This period of time can be a challenge for elders as they attempt to find a new meaning and purpose in their life. In general, meaning is defined as a psychological concept that is correlated with the feeling we have when we make a difference and matter to others. Purpose in life is defined something we get from a more long-term life project. As we age it is common to have a lack of purpose in life. This is because in life, one has probably already accomplished major goals like raising a family or peaking in their career. Additionally, as the lifestyles slow down it is harder for seniors to find opportunities to contribute their skills, therefore they have to seek out new opportunities [3]. In Martin Pinquart’s meta-analysis of 70 empirical studies, he concludes that there was a stronger decline in purpose of life in people ages 60 and older than those in a younger sample. This supports the notion that as we age, it is more challenging to find and maintain a purpose in life. Overcoming these challenges is very important to improving health as we age. In a study performed by Eric Kim and colleagues, it was found that a purpose in life was associated with a reduced likelihood of stroke. In this study they used the Health and Retirement Study (HRS) which surveyed more than 22,000 American ages 50 and older every two years Kim et al. [10]. In 2006 they randomly selected 6,739 respondents from the HRS and followed them for four years to assess the stroke outcome measurement. They concluded that there was a statistically significant association between an increased perception of purpose in life and a decreased risk of having a stroke Kim et al. [10]. In addition to a reduced risk of stroke, purpose in life has also been associated with a reduced risk of death from cardiovascular disease. Koizumi and colleagues conducted a prospective study of almost 3,000 Japanese subjects which they observed over 13.3 years. Their results indicated that in men, having a sense of purpose in life reduced the risk of death by stroke and cardiovascular disease Koizumi [5]. These are very large health events that could be reduced if elders had a better purpose in life. In addition to large scale health events, a purpose in life has also been associated with improved physical function. Eric Kim and colleagues conducted a longitudinal cohort study on adults over 50 years old (2017).

In this study they observed almost 4,500 adults who had a grip score baseline considered normal for their age and almost 1,500 adults who had a walking baseline considered normal. After four years, their results indicated that one standard deviation increase in purpose in life was associated with a 13% decreased risk of a weak grip strength. Each standard deviation increase was actually associated with a moderate increase in grip strength, which is approximately the same as being three years younger. Additionally, the study found that one standard deviation increase in purpose in life was associated with a 14% decrease in the risk of developing a slow walking speed. In fact, they found that this standard deviation increase was associated with a moderate increase in walking speed, which was approximately equivalent to being 2.5 years younger. Lastly, Arlener Turner and colleagues studied 825 older adults (60 years or older) to assess sleep quality and its relationship with purpose in life. Their results indicated that participants with a higher purpose in life were more likely to have better sleep quality and less likely to develop sleep apnea and restless leg syndrome [11]. Therefore, having a purpose in life can be more challenging as we age, but having this purpose is associated with improved health and a decreased risk in dying from strokes or cardiovascular disease.

Current state of nursing homes

As medical and technological advancements have been made, it has increased life expectancy. This is becoming a global public health challenge as people ages 65 years and older are predicted to outnumber children younger than 5 years old for the first time in history Suzman et al. [12]. With this increase in the older population, it is important to think about where the elderly will fit in society. Currently in the United States, the majority of the older adults live in the community (93.5 percent which is 33.4 million) Wellman [13]. In 2016, there was an estimated 1.4 million people living in nursing homes with the majority ranging from 75-94 years old and two thirds of residents were women (Facts and Statistics About U.S. Nursing Homes). Additionally, in 2016 there were 15,600 nursing homes in the U.S. with 1.7 million licensed beds. Most of the time seniors move into nursing homes because they have health or cognitive impairments that cause barriers to living alone. Some of these impairments include arthritis, Alzheimer’s, dementia, eye diseases, amputations, and increased fall risk. In 2018, the median cost for a private room in a nursing home in the U.S was about $8,300 a month. Nursing homes are unique because they are both treatment facilities as well as many people’s new living situation, therefore quality of life and care are very important in these settings (Institute of Medicine (US). In nursing homes, it is important to maintain quality of life which can be associated with a satisfaction with life and having a feeling of self-worth. For example, a resident’s quality of life can be enhanced by having close relationships with others, having a supportive environment, and having the opportunity to make decisions about their care within reason [14,15]. Factors that could contribute to a lack of selfesteem would be a lack of privacy and a lack of variety and quality of food. The quality of care provided by nursing homes has been questioned many times in U.S. history, and in the late 1980’s the Institute of Medicine performed a landmark study that changed U.S. nursing homes. After this study, the U.S. government created and established requirements for nursing homes to improve the poor conditions they found. Even after this study and the reform, there are still many problems to be faced. Currently, nursing homes face a large financial pressure, increased acuity of care, and under staffing. Solutions to these problems can be difficult to achieve because the patients themselves can have a hard time advocating for themselves. Additionally, nursing staff can have poor leadership and management which leads them to rush care or even miss parts of the patients care Song et al. [16]. In a study done in 93 nursing homes in Canada, they found that the two most frequently missed and rushed tasks were walking and talking with the residents. Overall, nursing homes serve a diverse set of needs, which often costs a large sum of money. Even though the nursing home standards have improved, it can still be reformed to incorporate more mental well-being like having a purpose in life.

How to improve nursing homes

As stated previously, having a purpose in life can have a positive impact on several different aspects of health. Using this knowledge, it is possible to improve the health care in nursing homes. One way to improve the sense of having a purpose in life is staying creative. This could mean painting, making jewelry, writing poetry, and any other creative task/ hobby that people often neglect in their younger years. This can be implemented in nursing homes by offering craft times and providing supplies. Not only will this enhance social aspects of the resident’s lives, but it will also keep them in touch with their creative side. Additionally, they could make these crafts for their loved ones or donate them to a local charity which could even further enhance their purpose in life. Another way to improve having a purpose in life is practicing mindfulness because often times mindset can be the biggest challenge. This can be practiced in things like meditation or yoga. This would be useful in nursing homes because patients who may not have full mobility would still be able to participate since it is mostly a mental exercise. Additionally, changing up their daily routine can improve their sense of having purpose. While having some structure in your life is important doing the same tasks everyday can become boring and makes it harder to establish a meaningful purpose in life. A way to include this in nursing homes would be having different activities offered each week. For example, one day could be game night, another they could go for a walk or if they are unable to leave their room, they could watch a nature video to feel connected to the outdoors. Having different events planned will help the residents have something to look forward to and it will help those who may not have family members to come visit them and “change things up.” Lastly, opportunities to contribute can be very fulfilling for seniors. Some examples include taking care of a pet, taking care of plants, and volunteering in the community. These can be used in nursing homes as well because plants can be incorporated in the private rooms as well as the common areas. Patients who have the mobility could help the staff take care of the plants and those who may not be able to help would still benefit from having life and greenery around them. Getting involved in the community by volunteering does not mean they have to leave the nursing home. In fact, the nursing home could partner with local schools and have school students be pen-pals with the residents. This would help the residents feel like they are connected to the community and can even help them still feel like they are making a difference in someone’s life. Additionally, if they are physically able taking the residents to volunteer at low-impact locations like a library would help increase their socialization which would also help improve their sense of purpose in life. While these ideas are possible options to improve nursing home care, it may be difficult for current nursing home staff to have time to incorporate this. As stated above, nursing homes are facing a nursing shortage. However, nursing staff does not necessarily have to be the ones who help the residents with these types of activities. Some nursing homes are hiring allpurpose workers who can help with daily activities like cooking and cleaning, but they could also help facilitate activities and be there to speak to residents. If having another paid position is not an option for some nursing homes, volunteers from the community may be a good alternative as well. Overall, current nursing homes could be improved with more attention to the mental well-being of residents and helping them find a purpose in life in this stage of their life.

Having a purpose in life is very important for senior’s health, both physical and mental. Numerous studies have shown an association with a sense of purpose in life and improved health. These studies can be used to guide care in nursing homes. As technology and medicine advance, life expectancy will increase as well, which will leave us facing a health challenge. Caring for our seniors is a topic that must be addressed. Even though nursing home residents make up a small portion of the senior population, they are some of the most vulnerable because they often do not have family to rely on or look forward to seeing. Using this information and the information from the studies, improved care in nursing homes is possible. Some ideas include encouraging activities, engaging with the community, and having a responsibility. Autul Gawande reports on a study done New York where a physician noticed his nursing home residents being depressed. To improve this, he requested the nursing home get 2 dogs, 4 cats, and 100 birds. After some hesitation and backlash, the staff started to notice that the patients were eating better, dressing themselves, and even going out of their room more Gawande [17]. After studying the effects for over two years, they found that the residents in this nursing home were receiving half the number of prescription drugs as those in the control nursing home, and deaths fell 15% Gawande [17]. This further proves that changing the daily routine and taking responsibility (like watching a plant or animal) can improve nursing home resident’s health and provide them a purpose in life.

The analysis in this study shows that having a purpose in life can improve the physical health of patients. It is associated with a decreased risk in having a stroke and dying from cardiovascular disease. Additionally, having a purpose in life is associated with a reduced risk of experiencing reduced grip strength and a reduced risk of having a slower walking pace. Lastly, having a purpose was also associated with a decreased risk in having sleep apnea and suffering from restless leg syndrome Turner [14]. All of these are important health factors that can improve overall quality of life and increase longevity. Using this as evidence, it can guide the way we try and improve nursing homes. Nursing homes have struggled and currently struggle in certain areas like financial stress and understaffing. This can create barriers in care and can lead to nursing staff to forget or rush certain tasks. Unfortunately, most of the time these tasks are related to mental well-being such as walking with residents or talking with them. Keeping these challenges in mind, it is still possible to improve care in nursing homes and incorporate having a purpose in life. Some possible solutions include facilitating group activities that have creativity in mind, changing daily routines to keep the residents motivated and wanting to participate, and helping the residents engage in the community. These activities can be modified to all levels as residents of all abilities can participate and benefit. As stated before, nursing homes are already facing a staffing shortage so it may be difficult to include all of these tasks into their already busy schedule [16-21].
This is where all-purpose staff could be beneficial because they could help alleviate more of the mental well-being aspects that can be forgotten like walking and talking. If hiring more staff is not financially possible, partnering with volunteer programs or local schools could help fill this position without requiring monetary compensation. The solutions proposed in this paper are based on the research collected. Further research could enhance support for these solutions and possibly help nursing homes gain more funding to implement these changes. As the older population continues to grow it is becoming even more important to conduct research on how to improve their care and overall quality of life. The results of this paper aim to improve nursing home care, but the solutions to provide a sense of purpose in life could be used to help seniors in the community as well. More of the population should be aware of how having a purpose in life can improve health because this is something that will affect us all. Therefore, having a purpose in life is associated with improvements in health and these results can be used to propose changes to improve nursing home care.

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