Gerontological educational interventions for student nurses: a systematic review of qualitative findings

OBJECTIVES

This systematic review of qualitative studies explored interventions to improve student nurses' knowledge, attitudes or willingness to work with older people. Student nurses are likely to encounter older people in all health and aged care settings, however, research demonstrates that few have career aspirations in gerontological nursing.

METHODS

Qualitative systematic review method based on the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

Search of Medline, Embase, PsycINFO, EBSCOhost and Scopus yielded 1841 articles which were screened to include primary research about educational interventions to improve student nurses' knowledge, attitudes and/or willingness to work with older people. Data extraction was performed on the 14 included studies, and data were analysed using directed content analysis. The Mixed Methods Appraisal Tool (MMAT) was used the assess the quality of the studies.

CONCLUSIONS

Educational interventions included theory or practice courses, or a combination of theory and practice. While most interventions changed nursing students' negative attitudes towards older people, few increased their willingness to work with them. Practice courses had the most significant impact on willingness to work with older people. Quality assessment revealed methodical limitations. More research is needed to better understand the elements of practice interventions that enhance student nurses' knowledge, attitudes, and willingness to work with older people, so that they can be replicated.

Older persons making a life closure: experiences of loneliness in an academic nursing home - a phenomenological qualitative interview study

BACKGROUND

Loneliness is a public health concern and more than half of the residents in nursing homes experience lonliness. Risk factors are age and loss of close relatives.

PURPOSE

This study aimed to describe experiences of loneliness among older people living in an academic nursing home.

METHODS

Qualitative semi-structured interviews were conducted with ten older people and data analysed with systematic text condensation inspired by a phenomenological approach.

RESULTS

Three themes were identified: "Relatives and health care professionals matter"; "Acceptance and meaningful existence alleviate loneliness"; and "Challenges affecting the experience of loneliness". The older persons described themselves as lonely, but their experience of loneliness differed. They managed loneliness by adapting to it or getting used to it; some also chose to be alone. To add meaningfulness to their daily life, talking about memories and their past were appriciated. Personality traits and variations in functional ability were identified as barriers to social interactions.

CONCLUSIONS

Health care professionals can reduce negative experiences of loneliness by listening to nursing home residents, creating a meaningful daily life with individualized activities, and by encouraging contacts with close relatives. This can be a way of maintaining older persons' dignity and coping with the longing for what has been.

Dental prosthesis plaque index of Augsburger and Elahi: Expansion and standardisation in community-dwelling frail older people

BACKGROUND

Inadequate daily oral hygiene care of dental prostheses could worsen general health of frail older people. The index of Augsburger and Elahi is often recommended to assess maxillary dental prosthesis plaque (DPP).

OBJECTIVE

To assess the reliability of an expanded and standardised DPP index of Augsburger and Elahi in trained and untrained examiners, and to determine the applicability of the index in community-dwelling frail older people.

METHODS

Ten community-dwelling frail older persons with complete and partial removable dental prostheses (RDPs) (mean ± SD age = 87.9 ± 8.4 years) participated. Seven persons were revisited after 3 months. The index was expanded with mandibular RDPs. Standardisation was achieved with a specially designed reference sheet. The RDPs were photographed after plaque colouring. Two trained examiners scored the photographs; thereafter, two untrained examiners. One trained examiner scored the photographs again after 3 weeks. Changes in DPP over the 3-month period were assessed with Wilcoxon signed-rank test. Inter- and intra-examiner reliability was assessed with intraclass correlation coefficients (ICCs).

RESULTS

The DPP scores did not change significantly over time (Z = -0.594, p = 0.553). Inter-examiner reliability was excellent in the trained examiners (ICC = 0.859-0.947), and fair-to-good in the untrained examiners (ICC = 0.671-0.703). Intra-examiner reliability was excellent (ICC = 0.941-0.962).

CONCLUSION

The proposed expansion and standardisation of the DPP index has an excellent inter- and intra-examiner reliability when performed by trained examiners, and a fair-to-good inter-examiner reliability by untrained examiners. Therefore, the index could be recommended for application in dental prostheses-wearing older persons and could be useful for awareness and education of professional and informal caregivers and the older persons themselves.

TRAIL REGISTRATION

The Netherlands Trail Register NTR6159.

(Re)conceptualising Good Care in Hospital Settings From the Perspectives of Older Persons: A Concept Analysis Using Pragmatic Utility

PURPOSE

To understand good care from the perspective of hospitalised older persons.

BACKGROUND

Older persons are the largest group of hospital users, and numbers will increase in the next decades. Hospital organisations are attempting to transform traditional care models to meet the specialised needs of hospitalised older persons. To achieve this, healthcare providers including nurses and administrators need to understand the perspectives of hospitalised older persons on what constitutes good care. This knowledge is critical to nursing to ensure that care aligns with the perceived needs of hospitalised older persons. However, good care from the viewpoints of hospitalised older persons remains ambiguous and poorly delineated in the literature.

METHODS

We conducted a concept analysis using the pragmatic utility method. To identify peer-reviewed articles, we searched CINAHL, MedLine, PsycINFO, Scopus and Embase databases for related literature using the keywords and related terms to 'good care', 'hospital or acute care' and 'older persons'.

RESULTS

Twenty-two peer-reviewed articles out of 2144 search results were included. The heterogeneity of older persons' perspectives and limitations in the literature on good care led to a tentative understanding. Good care, a partially mature concept, is the provision of person-centred, culturally sensitive, holistic and integrated care that fosters autonomy, control and participation, resulting in a sense of belonging, smooth transitions, optimal management of clinical conditions, satisfaction in care and informed older persons and family caregivers.

CONCLUSION

Older persons are a heterogeneous group with diverse perceptions of good care. Instead of seeking a common understanding of good care, efforts should be focused on identifying individual preferences, values and goals of hospitalised older persons.

IMPLICATIONS FOR PRACTICE

The components of good care are important for many hospitalised older persons and can serve as a starting point for improvements in practice settings. However, this understanding is tentative and may overlook critical aspects of care at an individual level. Hospital organisations, healthcare providers and nurses should be cognizant of this limitation and cultivate adaptability for an individualised approach to care.

Effects of repetitive peripheral magnetic stimulation on knee joint extensor strength in older persons receiving day services

Kamiue M, Tsubahara A, Ito T, Koike Y. Effects of repetitive peripheral magnetic stimulation on knee joint extensor strength in older persons receiving day services. Jpn J Compr Rehabil Sci 2024; 15: 49-57.

Objective

To verify the effects of repetitive peripheral magnetic stimulation (rPMS) on knee joint extensor strength and motor ability in older adults receiving day services.

Methods

Thirty Hz rPMS using Talent Pro® was applied to the bilateral vastus lateralis, vastus medialis, and rectus femoris of 12 older persons (mean age 83.8 ± 4.5 years) attending a day service center and receiving functional training by a physical therapist. The intervention was performed for 20 minutes per day, three times per week, for a total of 4 weeks. Evaluations before and after the intervention included maximum voluntary contraction (MVC), knee extensor torque induced by rPMS (rPMS-induced torque), pain (visual analog scale: VAS), thigh circumference, comfortable 5-m walking time, 30-second chair-stand test (CS-30), Timed-Up-and-Go Test (TUG), and Functional Reach Test (FRT). MVC and rPMS-induced torque were measured using the μ-Tas F-1®.

Results

MVC significantly increased in both lower limbs after the intervention (right/left: 72.4 ± 23.5 Nm/72.9 ± 23.0 Nm) compared with immediately before the intervention (right/left: 59.9 ± 17.2 Nm/64.5 ± 21.0 Nm). No significant changes were observed in MVC between one month before the intervention and immediately before the start of the intervention, and between the end of the intervention and one month after the end of the intervention. rPMS-induced torque, TUG, and CS-30 improved significantly after the intervention compared with immediately before the intervention.

Conclusion

Intervention using rPMS increases MVC- and rPMS-induced torque and improves motor ability in older adults. Because rPMS is a simple means of increasing muscle strength, it is expected to be widely used in the future.

Monitored and Cared for at Home? Privacy Concerns When Using Smart Home Health Technologies to Care for Older Persons

BACKGROUND

States and families are facing growing challenges provide adequate care for older persons. Smart home health technologies (SHHTs) in the forms of sensor or robotic devices have been discussed as technical solutions for caregiving. Ethical and social concerns are raised with the use of such technologies for caregiving purposes, a particularly prominent one being privacy. This paper contributes to the literature by distinguishing privacy concerns into both the type of technologies and conceptual dimensions.

METHODS

Data for this paper stem from sixty semi-structured interviews with older persons, informal, and formal caregivers living in the German-speaking regions of Switzerland. All information related to privacy, that were initially inductively coded, were thematically sorted into four dimensions of privacy (physical, psychological, social, and informational) and by the type of technologies studied.

RESULTS

Participants were especially concerned about privacy intrusions from smart wearables and ambient sensors than robotic technologies, which may be due to the relative lack of familiarity with the latter. Informational privacy was evident in the context of data collection capacities and potential for misuses of data. The installation and implementation of both visual and ambient sensors induced discomfort to their senses of physical space. Alerts of smart wearables and obtrusive sightings of SHHTs garnered worries related to stigmatization and manipulation, indicating intrusions into end-users' psychological privacy. Little discussions of social dimensions of privacy were evident in the data, even toward robotic technologies for their functions to promote social interactions for older persons.

CONCLUSIONS

This paper is one of the first that use the stratification approach on empirical data to highlight the multi-faceted privacy concerns when technologies may be implemented in elder care. Our paper could thus supports potential end-users in deciding which technologies to use and how to balance different privacy concerns against other values that they may hold important.

Oral Health Status at Age 60 and 72 Years-A Longitudinal Study

OBJECTIVE

This study investigated oral health status in 60-year-old individuals over 12 years.

MATERIALS AND METHODS

Data were obtained from The Swedish National Study on Aging and Care (SNAC). One hundred nineteen 60-year-old individuals (48% females) underwent a clinical and radiographic baseline examination (2001-2003) and follow-up examination in 2013-2015. For statistical analyses, paired t-tests and McNemar's test were performed. Statistical significance was determined at p < 0.05.

RESULTS

At the 12-year follow-up, the mean number of teeth and the proportion of individuals having ≥ 20 teeth decreased (p < 0.001). The mean number of teeth with buccal/lingual and approximal caries lesions increased (p < 0.029 and p < 0.031). Individuals with a distance from the cement-enamel junction to the bone of ≥ 5 mm increased in total (p < 0.002) and in males (p < 0.006). The prevalence of gingivitis increased in total (p < 0.001). The prevalence of periodontitis showed a significant increase in total (p < 0.043) and in females (p < 0.039).

CONCLUSION

The present study indicates that oral health status in 60-year-old individuals deteriorates over 12 years. However, the deteriorations were minor in terms of tooth loss, caries lesions, and changes in periodontal status.

Understanding Older Persons' Experiences of Care Encounters in the Home Environment: A Hermeneutic Study

AIM

To explore and gain a deeper understanding of older persons' experiences of care encounters when their home becomes a workplace.

BACKGROUND

Worldwide healthcare services are increasingly being provided in older persons' homes by registered nurses. This presents new challenges as the home environment of older persons now doubles as a workplace for healthcare professionals. However, there is limited research available on how older persons experience care encounters when their homes serve as workplaces and how this influences their overall well-being and quality of life.

DESIGN

A qualitative hermeneutic study.

METHODS

In-depth face-to-face interviews were conducted in Sweden from October 2023 to January 2024 with 10 purposefully selected older persons (aged 65+). Each participant received regular visits from a home care nurse in their home to address specific care needs, such as wound care, medication administration, blood sampling and general supervision. The interviews were audiotaped, transcribed verbatim and analysed using a hermeneutic interpretation.

FINDINGS

The hermeneutic analysis emerged with one main theme: 'Experiencing care encounters at home as a lottery', with two underlying themes: 'Adapting to loss of control in the private sphere' and 'Striving for independence while navigating daily living'.

CONCLUSIONS

Older persons try to control their lives despite the challenges associated with ageing and receiving care at home. They strive to maintain their independence and autonomy, which reflects their desire for self-determination. Supporting these efforts in an interdependent relationship can enhance their well-being and quality of life.

REPORTING METHOD

Findings were reported following the Consolidated Criteria for Reporting Qualitative Research guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Data were collected by patient interviews.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This study emphasises the importance of supporting older persons in maintaining control over their lives while being cared for in their homes. In the care encounters with home care nurses, their well-being and quality of life can be improved by respecting their autonomy, involving them in decision-making and offering tailored support.

Leading care close to the patient in community home care for older persons: A lifeworld hermeneutic study from nurses' perspectives

AIM

To explain and understand leading care close to older persons in community home care from the perspective of registered nurses (RNs).

BACKGROUND

Leading care close to older persons in home care is an overlooked and not well-described phenomenon. In home care, specific demands are placed on the registered nurse, as responsible for leading care guided by the older person's expectations and desires.

DESIGN

A reflective lifeworld hermeneutic approach grounded in the philosophy of phenomenology and hermeneutics. The study followed the COREQ checklist.

METHODS

Individual interviews were conducted with nine RNs working in community home care in a community in western Sweden. The data were analysed with a lifeworld hermeneutic approach.

RESULTS

The findings present four partially interpreted themes: leading with respect in a shared space, leadership that involves existential questions of life, balancing responsibility enables preservation of autonomy and challenges in maintaining a patient perspective. The partially interpreted themes conclude in a main interpretation: The patient perspective as an anchor when balancing responsibility for another person in an existential vulnerability of life.

CONCLUSION

Leading care means being both close to the patient and at a distance when caring is performed through the hands of others. Ethical demands are placed on RNs as they encounter the vulnerability of the older person.

RELEVANCE TO CLINICAL PRACTICE

The findings can contribute to a greater understanding of the meaning of RNs as leaders and may have an impact for decision makers and policies to create conditions for leadership that contributes to dignified care for older persons in community home care.

PATIENT OF PUBLIC CONTRIBUTION

Registered nurses working in community home care participated in data collection.

Influence of Reading or Writing Activities Shared with Others on Older Adults: Results From a Scoping Study

This study aimed to provide integrated knowledge on the influence of shared reading or writing activities, that is, recreational occupations involving dynamic relationships based on personal development, on adults aged 55 and older. Using a scoping study framework, six databases were searched with 25 relevant keywords for papers, theses, and scientific reports published in 2001-2023. Based on the Human Development Model-Disability Creation Process, the content analysis of 20 documents showed that shared reading or writing activities mostly benefited aging adults' behavioral capabilities like positive affect, their intellectual capacities, such as developing new perspectives on life, their interpersonal relationships, and social support. Negative instances, such as frustration, were often mentioned at the beginning of the activities but decreased over time. These results suggest the importance of shared reading or writing activities for healthy aging and the necessity to better support these activities for more inclusive and caring aging societies.

Older persons' knowledge of HIV and AIDS prevention in a province of South Africa

BACKGROUND

 Population ageing and access to antiretroviral therapy have resulted in an increase in the proportion of older people living with human immunodeficiency virus (HIV). However, scant knowledge is available to inform the design of educational programmes to target these persons in low- and middle-income countries.

AIM

 This study aimed to examine how persons aged ≥ 50 years view their risk of contracting HIV, and the extent to which they are supported in preventing infection and are impacted by the HIV or acquired immune deficiency syndrome (AIDS) epidemic.

SETTING

 Rural sites in the Western Cape Province of South Africa.

METHODS

 This study followed a qualitative design. Two focus group discussions with persons aged ≥ 50 years and interviews with two key informants were conducted at seniors' centres. Discussions were digitally audio recorded and the recordings were transcribed, and data were thematically analysed.

RESULTS

 Overall, awareness of the risk of older persons contracting HIV infection in this population was poor. Stigmatisation of the disease in the community and at health care facilities affected individuals' willingness to be tested for the virus and/or to disclose their status, if positive. Participants viewed HIV and AIDS education programmes as focussed on the youth and educational sessions for large groups were not helpful in stemming the epidemic.

CONCLUSION

 Dissemination of information on older persons' vulnerability to the disease, and education on HIV and AIDS tailored for and targeted at this age group have been relatively neglected.Contribution: Educational programmes on HIV, as well as productive channels and platforms to target older populations, particularly those with a low health literacy level are required.

Factors Associated with Differences in Physicians' Attitudes toward Percutaneous Endoscopic Gastrostomy Feeding in Older Adults Receiving End-of-Life Care in Japan: A Cross-Sectional Study

Background

Although percutaneous endoscopic gastrostomy (PEG) placement is still widely practiced in Japan, studies from Western countries report that it is less beneficial for patients in end-of-life care with cognitive decline. Decisions regarding PEG placement are largely influenced by physician judgment.

Objectives

The aim of this study was to investigate the background and perceptions of Japanese physicians regarding PEG for older adults in end-of-life care and to identify the factors associated with differences in physician judgment regarding PEG.

Design

The study employed a cross-sectional design.

Setting/Subjects

A questionnaire on PEG for older adults in end-of-life care was sent to Japanese physicians. Logistic regression analysis was used to calculate the odds ratios (ORs) and confidence intervals (CIs) of the association between PEG recommendations and each factor.

Results

PEG placement was advised for bedridden patients and older adults with cognitive decline by 26% of the physicians who responded to the survey. Differences in physician perceptions of PEG feeding were associated with the recommendation for PEG, benefits of preventing aspiration pneumonia (OR: 4.9; 95% CI: 3.1-8.2), impact on post-discharge accommodation decisions (OR: 6.1; 95% CI: 1.9-30.9), and hesitancy to recommend a PEG placement (OR: 1.9; 95% CI: 1.3-4.5). Working in a facility with PEG placement (OR: 2.0; 95% CI: 1.2-3.5) was an associated background factor.

Conclusions

Differences in Japanese physicians' attitudes toward using PEG feeding for older adults in end-of-life care were significantly associated with differences in their perceptions of the impact of PEG feeding and working in a facility with PEG placement.

Professional identity formation of medical students in relation to the care of older persons: a review of the literature

With the growing population of older persons, medical students have to be well prepared for older persons' health care during medical school. Becoming a doctor is an interplay of building competencies and developing a professional identity. Professional identity formation of medical students is a relatively new educational concept in geriatric medical education. This review aims to explore the concept of professional identity formation of undergraduate medical students in relation to the care of older persons. Twenty-three peer-reviewed studies were included and summarized narratively. Patient-centeredness, caring and compassion, collaboration and holistic care are characteristics of the doctor's professional identity in relation to the care of older persons. Participating in the context of older persons' health care contributes to the becoming of a doctor in general. In this context, the building of relationships with older persons, participating in their lives and role models are important influencers of professional identity formation. Furthermore, the perceptions and expectations medical students have of future doctoring influence their feelings about the care of older persons. To prepare medical students for older persons' health care, professional identity formation seems to be a relevant educational concept.

Fall status and risk factors in older Chinese adults: A cross-sectional study

AIM

To analyse the risk factors and incidence of falls in geriatric outpatients in a university hospital ward in Hangzhou, China.

METHODS

From May 2020 to August 2022, 1712 geriatric outpatients in a university hospital ward in Hangzhou, China, were screened using a socio-demographic questionnaire (e.g. gender, age, living arrangement, etc.) and assessment scales. The correlation between each factor and falls was preliminarily analysed by chi-squared tests. Finally, binary logistic regression analysis was conducted to further analyse the risk factors of falls. The STROBE checklist was used in reporting this study.

RESULTS

Of the 1712 geriatric outpatients recruited, 1626 participants (60-79 and ≥ 80 years old) with complete questionnaire and assessment data were included. The occurrence of falls for those in the 60-79 age group was 8.4%, and for those in the ≥80 age group it was 13.4%. Age (p = .007), use of a walking assistance device (p < .001), the Stay Independent Brochure Questionnaire (SIB) (OR = 7.751, 95% CI = 5.089-11.806, p < .001), living arrangement (p = .004), timed up and go test (TUGT) (p = .007) and three diseases or above (OR = 2.496, 95% CI = 1.358-11.4.586, p = .003) reached statistical significance.

CONCLUSIONS

Older people have a high incidence of falls. In this study, age, disease history, SIB scores (≥4 points), living arrangement, TUGT and walking assistance device increased the probability of falls in older Chinese adults. Personalised interventions should be carried out according to the specific situation of older people to effectively reduce their incidence of falls and improve their quality of life.

RELEVANCE TO CLINICAL PRACTICE

The basic characteristics and fall risk factors of the older can help nurses identify fall risk, and early intervention by caregivers can reduce fall-related injuries, which has practical significance for promoting healthy aging.

PATIENT OR PUBLIC CONTRIBUTION

The subjects of this study were older patients ≥60 years old, and the demographic characteristics and fall-related information of patients were obtained by questionnaire. The team worked closely with a team of experts in the field of health care. Some researchers collect data and rewrite them, while other researchers analyse the information and write a paper. All authors read and approved the final manuscript.

Comparison of Mini Nutritional Assessment Tool and Geriatric Nutrition Risk Index in Predicting 12-Y Mortality Among Community-Dwelling Older Persons

BACKGROUND

Malnutrition is a common and dangerous condition in older adults, which has been associated with increased risk of mortality.

OBJECTIVES

This study aimed to evaluate and compare the abilities of Mini Nutritional Assessment short form (MNA-SF), MNA full form (MNA-FF), and geriatric nutritional risk index (GNRI) to predict all-cause and expanded cardiovascular disease (CVD)-related mortality in community-dwelling older adults.

METHODS

This research was an observational cohort study conducted in a community setting, with a 12-y follow-up involving 1001 community-living older adults aged 65 y or older who were enrolled in 2009 and followed up until 2021. Nutritional status assessment was carried out in 2009 using MNA-SF, MNA-FF, and GNRI. Multivariate Cox proportional hazards regression was applied to determine adjusted hazard ratios of mortality with 95% CIs.

RESULTS

A total of 368 deaths (36.76%) and 122 expanded CVD-related deaths (12.19%) were observed after a median follow-up of 12 y. Compared with normal nutritional status, poor nutritional status assessed by the MNA-SF, MNA-FF, and GNRI was found to be associated with an increased all-cause mortality in older persons. MNA-SF and MNA-FF, but not GNRI, were associated with expanded CVD-related mortality. The MNA-FF showed better discriminatory accuracy for all-cause (C-statistics: 0.77; 95% CI: 0.63, 0.79) and expanded CVD-related mortality (C-statistics: 0.79; 95% CI: 0.70, 0.83) than MNA-SF (C-statistics: 0.76; 95% CI: 0.73-0.79; and C-statistics: 0.76; 95% CI: 0.72-0.81, respectively) and GNRI (C-statistics: 0.75; 95% CI: 0.73-0.79; and C-statistics: 0.76; 95% CI: 0.72-0.80, respectively).

CONCLUSIONS

Our findings indicate that MNA-SF, MNA-FF, and GNRI were all independent predictors of all-cause mortality. In particular, the MNA-FF may be the best nutritional assessment tool for predicting all-cause and CVD-related mortality among older persons residing in community, compared with MNA-SF and GNRI.

Older persons' experiences of care encounters in their home: A multiple-case study

AIM

To explore and describe older persons' unique experiences of care encounters with home care nurses in a real-life context.

BACKGROUND

The increasing number of older persons in society contributes to increases in age-related impairments compromising their quality of life. Future care consists of "hospitals at home" where care encounters occur in a person's private domain, partly becoming a clinical workplace. Scant research has focused on how older persons experience care encounters with home care nurses and needs to be highlighted.

DESIGN

Multiple-case study.

METHODS

The cases relied on replication logic and five purposive sampled older persons were interviewed. Data were analysed using qualitative content analysis and differences within and between cases were explored and findings across the cases were replicated.

FINDINGS

The cross-analysis emerged in three categories: "Nursing routine rules the care encounters", "Lack of knowledge and information" and "Dependency on support from others".

CONCLUSIONS

Our research has found that older persons face challenges while receiving home care, including limited engagement in their care and the need for enhanced support. Implementing person-centred care in homes poses ethical challenges that require careful consideration. Home care nurses should prioritise understanding each patient individually, recognising them beyond their patient role, which necessitates more thorough and time-sensitive care encounters.

REPORTING METHOD

Findings were reported using COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Patients were interviewed and contributed with data for this study.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This study emphasises the need to prioritise individualised care in home settings and listen to the voices of older individuals to enhance quality.

Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services

BACKGROUND

Participation in care is considered to promote safe and qualitative care. Care-dependent older persons ageing in place have increased emergency care needs, which initiate inter-organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations.

AIM

This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care-dependent older persons experiencing acute illness at home.

DESIGN

This study has a qualitative design with a lifeworld approach.

METHOD

A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care-dependent persons aged 70-93 years.

RESULTS

Care-dependent older persons' participation in prehospital emergency care means 'Entrusting life to professional caregivers' when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain.

CONCLUSION

Care-dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well-being and continued living.

IMPLICATIONS FOR PRACTICE

Prehospital emergency care from the perspective of care-dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld-led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.

Multidrug-resistant Stenotrophomonas maltophilia in residential aged care facilities: An emerging threat

Stenotrophomonas maltophilia is a multidrug-resistant (MDR), Gram-negative bacterium intrinsically resistant to beta-lactams, including last-resort carbapenems. As an opportunistic pathogen, it can cause serious healthcare-related infections. This study assesses the prevalence, resistance profiles, and genetic diversity of S. maltophilia isolated from residential aged care facilities (RACFs). RACFs are known for their overuse and often inappropriate use of antibiotics, creating a strong selective environment that favors the development of bacterial resistance. The study was conducted on 73 S. maltophilia isolates recovered from wastewater and facility swab samples obtained from three RACFs and a retirement village. Phenotypic and genotypic assessments of the isolates revealed high carbapenem resistance, exemplifying their intrinsic beta-lactam resistance. Alarmingly, 49.3% (36/73) of the isolates were non-wild type for colistin, with minimum inhibitory concentration values of > 4 mg/L, and 11.0% (8/73) were resistant to trimethoprim-sulfamethoxazole. No resistance mechanisms were detected for either antimicrobial. Genotypic assessment of known lineages revealed isolates clustering with Sm17 and Sm18, lineages not previously reported in Australia, suggesting the potential ongoing spread of MDR S. maltophilia. Lastly, although only a few isolates were biocide tolerant (2.7%, 2/73), their ability to grow in high concentrations (64 mg/L) of triclosan is concerning, as it may be selecting for their survival and continued dissemination.

Comparison of four criteria for potentially inappropriate medications in older patients with newly diagnosed non-small cell lung cancer

BACKGROUND

Potentially inappropriate medication (PIM) use is a common problem among older patients. This study aimed to compare the prevalence of PIMs in older patients with newly diagnosed non-small cell lung cancer (NSCLC), and to identify the correlates of PIMs.

RESEARCH DESIGN AND METHODS

A secondary analysis of a prospective cohort study was conducted. Patients were enrolled from January 2014 to December 2020 and information were extracted from patients' electronic medical records (EMRs). We evaluated the PIMs using four different PIM criteria. The concordance among the four PIM criteria was calculated using kappa tests. The possible risk factors associated with PIMs were analyzed by multivariate logistic regression.

RESULTS

The prevalence of at least one PIM identified by the four criteria ranged from 25.1% to 48.2% among 514 patients. There was moderate consistency between the GO-PIM scale and the AGS/Beers criteria, while poor consistency with the other criteria (the STOPP criteria and the Chinese criteria). Polypharmacy was found to be significantly associated with the occurrence of PIMs in all criteria (p < 0.001).

CONCLUSIONS

Our results showed a high prevalence of PIMs in older patients with NSCLC, which was significantly associated with polypharmacy, and the consistency across the four criteria was poor-to-moderate.

Use of Adjuvanted Quadrivalent Influenza Vaccine in Older-Age Adults: A Systematic Review of Economic Evidence

Influenza vaccination is an important public health measure that can reduce disease burden, especially among older persons (those aged 65 and over) who have weaker immune systems. Evidence suggests enhanced vaccines, including adjuvanted quadrivalent vaccines (aQIV), may be particularly effective in this group. This study reports the results of a systematic review of the cost-effectiveness of aQIV in this population. The review was undertaken and reported in accordance with good practice guidelines. Medline and EMBASE were searched from 2013 to the present. Pre-selected eligibility criteria were employed and quality assessment undertaken using the Consensus Health Economic Criteria (CHEC-extended) checklist and Consolidated Health Economic Evaluation Reporting Standard (CHEERS) 2022 checklists. A total of 124 records were returned, with 10 full text papers retained. All were modelling studies and exhibited heterogeneity in approach, perspective, and parameter estimation. Nine papers reported cost-effectiveness ranging from EUR 6694/QALY to EUR 20,000/QALY in evaluations employing a payer perspective and from EUR 3936/QALY to EUR 17,200/QALY in those using a societal perspective. Results remained robust to a range of sensitivity analyses. One paper that reported contrary findings adopted a distinct modelling approach. It is reasonable to conclude that there is a broad consensus as to the cost-effectiveness of aQIV in this population group.

"We Used to Have Four Seasons, but Now There Is Only One": Perceptions Concerning the Changing Climate and Environment in a Diverse Sample of Israeli Older Persons

Solastalgia is the pain caused by the loss of solace and isolation from one's environment. Solastalgia is contrasted with nostalgia, which is defined as melancholy characterized by homesickness or the distance from one's home. The present study examines the two concepts of solastalgia and nostalgia in the context of climate change among diverse populations of older Israelis. In total, 50 older persons from four different population groups (e.g., veteran Israeli Jews, Israeli Arabs, immigrants from the former Soviet Union, and Ethiopian immigrants) were interviewed. All interviews were transcribed and analyzed thematically. Members of all four groups expressed emotional distress and grief associated with the changing climate, increased environmental pollution, and the disappearance of nature. Perceptions around the undesirability of these changes were quite unanimous, thus leading us to conclude that the outcomes associated with solastalgia and nostalgia are quite similar despite different etiological explanations.

Older persons' experiences of frailty: A systematic review

OBJECTIVES

The objective of this study was to synthesise the evidence of older persons' experiences of frailty.

BACKGROUND

The world's population is ageing with those aged over 60 years expected to total 2 billion by 2050. Although not exclusive to ageing, there is a higher prevalence of frailty in older adults, with corresponding demand for related healthcare. While definitions of frailty are debated, there is emerging consensus that sole reliance on biomedical conceptualisations is inadequate to capture the complex needs of older persons living with frailty. In addition, the voices of older persons have largely been excluded from frailty discourses. There is a consequent need for an expanded approach.

METHODS

A meta-synthesis was conducted of the literature on older persons' experiences of frailty. CINAHL, Medline, Embase and ASSIA databases were systematically searched up to January 2024. Reference lists of retrieved sources and grey literature were also searched. Studies were independently evaluated for inclusion by two reviewers using predetermined inclusion criteria. Included studies were quality appraised using a standardised tool, and extracted data were thematically analysed and synthesised.

RESULTS

Eight hundred and thirteen studies were identified as potentially relevant. Following title and abstract review, 52 studies were selected for full-text review. Thirty-four studies were subsequently excluded as they did not address the systematic review question, leaving 17 included in the final review. An additional two studies were identified via grey literature sources. Older persons' experiences of frailty were synthesised with reference to three themes: (i) living with frailty: a multidimensional experience; (ii) living with frailty: acceptability and associations; and (iii) living with frailty: resisting and adapting and losing control.

CONCLUSIONS

Older persons' experiences of frailty revealed a resistance to the biomedical use of the term generally used in clinical practice. Instead, a more nuanced and multidimensional understanding of frailty was identified in the experiences of older persons.

IMPLICATIONS FOR PRACTICE

Health and social care personnel should therefore consider an expanded approach in practice that incorporates the perspective of older people who strive to maintain independence and control when living with frailty. Doing so may enhance shared understanding and person-centred care planning between older persons and professionals.

The well-being equation: How inner fulfilment drives the impact of older persons on the Ghanaian society

BACKGROUND

Understanding and managing the complex processes of ageing is a critical function of gerontological nursing, especially when it comes to older people's well-being and their contributions to society. Globally, older persons contribute in many ways to families and communities. However, the relationship between older person's overall well-being and their propensity to contribute to society remains an important gap in research.

OBJECTIVE

The study examined the association between well-being and the impact of older persons on Ghanaian society.

METHODS

A secondary analysis of longitudinal survey data of the 2014/15 Study on Global Ageing and Adult Health (SAGE Wave 2) conducted by the World Health Organization was used. The multilevel logistic regression technique was used to examine four dimensions of well-being and their associations with high social contribution among older persons. The output was reported as odds ratios (OR).

RESULTS

The results show that older persons who had high physical and psychological well-being were more likely to contribute to society (OR = 1.25, 95% CI = 0.93, 1.68), (OR = 1.75, 95% CI = 1.32, 2.33). However, those with high levels of emotional and spiritual well-being were less likely to make social contributions (OR = 0.66, 95% CI = 0.49, 0.88), (OR = 0.88, 95% CI = 0.66, 1.18).

CONCLUSION

This study shows a positive association between well-being and older persons' societal impact. Good mental and physical health encourage societal involvement among older persons, while high emotional and spiritual well-being may lead to less societal contribution.

IMPLICATIONS FOR PRACTICE

These findings are important for nursing policies promoting social contribution and well-being among older persons 60 years and over in Ghana.

Potentially Inappropriate Medications in Hospitalized Older Patients in Tabuk, Saudi Arabia Using 2023 Beers Criteria: A Retrospective Multi-Centric Study

Purpose

Older persons are frequently prescribed several medications; therefore, inappropriate medication prescriptions are common. Prescribing potentially inappropriate medications (PIMs) poses a serious risk and hence, we aimed to assess the PIMs in older patients in Tabuk, using the 2023 Beers criteria.

Patients and Methods

A retrospective cross-sectional study was carried out, including older persons ≥65 years of age admitted in two government hospitals from June 2022 to May 2023, and prescribed with five or more medications. PIMs were assessed using the 2023 Beers criteria. Descriptive analysis was performed for the categorical and continuous variables. Logistic regression was used to assess the influence of age, gender, number of medications and comorbidities on PIMs using SPSS version 27.

Results

The study included 420 patients. The mean age of the participants was 75.52 ± 8.70 years (range, 65-105 years). There was a slightly higher proportion of females (52%). The prevalence of PIMs was 81.43%, where 35.41% were prescribed one PIM, 26.48% were prescribed two PIMs, and 17.32% were prescribed three PIMs. The proportion of medications considered potentially inappropriate among older patients was 70.11%, and proton pump inhibitors were the most commonly prescribed medication (52.99%). The proportion of medications to be used with caution was 19.55%, with diuretics being the most frequently administered medication (91.43%). Gender and comorbidity did not influence PIMs, but age and number of medications significantly influenced the likelihood of PIMs.

Conclusion

PIMs are prevalent among older people and are significantly associated with age and multiple medications. Caution should be exercised while prescribing medications to older persons. Frequent audits should be performed to assess PIMs, and clinicians should be informed of the same to avoid serious outcomes associated with PIMs. Interventions designed to reduce PIM need to be initiated.

Exploring community mental health service use following hospital-treated intentional self-harm among older Australians: a survival analysis

OBJECTIVES

This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH.

DESIGN

A longitudinal whole-of-population record linkage study was conducted (2014-2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data.

SETTING

Australia's most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review.

PARTICIPANTS

Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older.

INTERVENTION

CMH care within 14 days from index, versus not.

MEASUREMENTS

Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates.

RESULTS

Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall.

CONCLUSIONS

CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.