A realist review of the contribution of person-centred cultures to the management of depression among older persons in nursing homes.

Background Person-centeredness is espoused in many national and international policies and standards and are viewed to inform cultures of care in nursing homes and influence mental health of older adults. In spite of this, studies have shown mixed results regarding the impacts of person-centred cultures on depression with outcomes depending on contexts and implementation approach. In addition, the prevalence of depression in nursing homes remains high. Objective This review aimed to understand how, why and in what contexts person-centred cultures, the expected cultures of care in nursing homes, contribute or not to the management of depression among older adults using a realist review. Method Realist review is a theory-driven review which explains whether or not an intervention works, how, why and in what contexts, in forms of theories. The theories are in forms of contexts, mechanism, and outcome configurations - CMOCs. This review followed four -step design by Pawson and colleagues and was informed by four initial programme theories. This is a phase two of a wider study. A systematic search of eight data bases including grey literature was conducted to gather evidence to refine the initial programme theories in collaboration with expert and local reference panels. Results Forty context, mechanism and outcome configurations derived from thirty relevant and rich papers were theorized, generating demi-regularities which informed the refinement/development of six programme theories. The programme theories highlight: the importance of staff education and leadership support for person-centred care. (ii) the importance of supporting older persons' autonomy through care planning and communication. (iii) supporting social connection and engagement for older persons through staff relationships. (iv) promotion of independence for older persons through environmental and relational support. (v) the importance of organisational enablers for sustainable person-centred cultures. (vi) the importance of environmental and organisational designs for social and psychological wellbeing of older persons. These show that person-centred cultures can mitigate against depression through individual (e.g. staff's confidence and competence), relational (trust, mutual familiarity) and organisational mechanisms. Conclusion This realist review highlights that person-centred cultures do contribute to the management of depression among older persons in nursing homes. These findings provide actionable insights into how organisational, relational and individual mechanisms interact within nursing homes to support the mental health of older persons. This study was prospectively registered with PROSPERO, ID CRD42024568251 on July 11, 2024.